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Summer 2020 - APA Foundations 2 - OB > Obstetric Anesthesia & Complications - Quiz 1 > Flashcards

Obstetric Anesthesia & Complications - Quiz 1 Flashcards

1
Q

What are the Neuro Changes of Pregnancy?

A

Decreased MAC, Epidural Space, and CSF

Engorged Epidural Veins

Increased LA Sensitivity

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2
Q

What are the Respiratory Changes of Pregnancy?

A

↑TV (40%)

↑RR (15%)

↑Minute Ventilation (50%)

↓PaCO2

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3
Q

Which of the following is decreased during Pregnancy?

A. Vital Capacity

B. Total Lung Capacity

C. Functional Residual Capacity

D. Dead Space

E. Airway Resistance

A

↓FRC (20%)

↓Dead Space

↓Airway Resistance

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4
Q

What Respiratory changes helps delivery of oxygen to fetus?

A

Increase of P50 Hemoglobin from 27 to 30 mmHg

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5
Q

What happens to the Respiratory Mucosa during Pregnancy?

A

Congestion d/t Vasodilation

Mucosal Engorgement = ↑Mallampati

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6
Q

What makes the mother prone to hypoxia during pregnancy?

A

↓FRC & ↑O2 Consumption

Preoxygenate & RSI w/ Cricoid Pressure

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7
Q

Why should Hyperventilation be avoided in Pregnancy during Anesthesia?

A

Low PaCO2 causes uterine vasoconstriction decreasing placental blood flow & left HgbO2 shift

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8
Q

What Intubation equipment should be available for Pregnant Patients?

A

Smaller ETT

Shorter Handle

Avoid Nasal Intubation

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9
Q

How is Oxygen Delivery optimized during Pregnancy?

A

↑Cardiac Output

Right HgbO2 Shift

↓PVR d/t Increased Progesterone

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10
Q

How is Plasma Volume affected by Pregnancy?

A

Increased Plasma Volume d/t Increased Renin

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11
Q

What are the different phases of changes in Cardiac Output during Labor?

A
  • Latent Phase: ↑15%
  • Active Phase: ↑30%
  • Second Stage: ↑45%
  • Postpartum: ↑80%
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12
Q

What are the CV changes during Pregnancy?

A

Blunted Adrenergic Response

Cardiac Hypertrophy

Heart Murmurs

↓Plasma Colloid Osmotic Pressure

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13
Q

What is Supine Hypotension Syndrome?

A

Hypotension, Pallor, N/V, and Diaphoresis when Preggos lie flat

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14
Q

What is the best position for Supine Hypotension Syndrome?

A

Left Lateral Uterine Tilt

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15
Q

How does the blood change in a pregnant patient?

A

Depressed Cell-Mediated Immunity

Hypercoagulation

PT/PTT decreases by 20%

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16
Q

Which Coagulation Factors are Increased during Pregnancy?

A

1, 7, 8, 9, 10, 12

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17
Q

Which Coagulation Factors are Decreased during Pregnancy?

A

11 & 13

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18
Q

Which Coagulation Factors are uneffected by Pregnancy?

A

2 & 5

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19
Q

What are the Renal Changes during Pregnancy?

A

↑Blood Flow & Filtration

↓BUN & Creat

Mild Glycosuria & Proteinuria

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20
Q

How does Pregnacy affect the Gastroesophageal Sphincter?

A

Reduced Competence & Tone

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21
Q

What are the GI Changes during Pregnancy might increase Aspiration Risk?

A

Increased Acid Secretion & Gastric Fluid

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22
Q

How is the Gallbladder affected by Pregnancy?

A

Sluggish & Gallstones d/t decreased CCK

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23
Q

How is the Liver affected by Pregnancy?

A

Decreased Pseudocholinesterase

(No effect on Sux Duration)

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24
Q

How does Pregnancy affect Blood Glucose?

A

Insulin Resistance = ↑Blood Glucose transfer to Fetus

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25
Q

What are the methods of transfer accross the Placenta?

A

Diffusion

Bulk Flow

Active Transport

Pinocytosis

Breaks

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26
Q

How long can the Fetus live without Oxygen?

A

10 minutes

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27
Q

What is the transfer of Oxygen to the Fetus dependent on?

A

Maternal Uterine Blood Flow vs. Fetal Umbilical Blood Flow

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28
Q

How much Oxygen is stored and consumed by the Fetus?

A

Stored O2: 42 mL

Consumed O2: 21 mL/min

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29
Q

How does the Fetus compensate for the Placental PaO2 of 40 mmHg?

A

Mom: Right HgbO2 Shift

Fetus: Left HgbO2 Shift & More Hgb

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30
Q

How is CO2 transfered across the Placenta?

A

Simple Diffusion

Fetal Hgb has lower CO2 affinity than Mom

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31
Q

Normal Uterine blood flow is 50 mL/min. How much is that increased during Pregnancy?

A

600-700 mL/min (10% of Cardiac Output)

80% of that goes to Placenta; the rest to Myometrium

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32
Q

What factors affect Uterine Blood Flow (UBF)?

A

BP

Uterine Vasoconstriction

Uterine Contractions

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33
Q

What anesthetic agents and drugs can decrease Uterine Blood flow?

A

Thiopental

Propofol

Gases > 1 MAC

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34
Q

How does Ketamine, Opioids, and N2O affect Uterine Blood FLow?

A

Little to No Effect

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35
Q

How does high serum Local Anesthetics affect the Uterus?

A

Uterine Vasoconstriction, but Neuraxial Analgesia can reduce Vasoconstriction

36
Q

What happens to infant’s heart & lungs at birth?

A

Oxygen filling lungs ↓Pulm. Vascular Resistance

↑LAP closes Foramen Ovale

↑Oxygen Tension closes Ductus

37
Q

What can happen if the Ductus remains open w/ Hypoxia or Acidosis?

A

Downward Spiral of Hypoxia & Acidosis d/t increase R-to-L Shunt

38
Q

When does normal Labor begin?

A

40 +/- 2 weeks after LMP

39
Q

What happens in the 1st Stage of Labor?

A
  • Latent Phase: Minor Dilation 2-4cm & Infrequent Contractions
  • Active Phase: Progressive Dilation to 10cm & Regular Contractions q3-5 min
40
Q

When is the 2nd Stage of Labor?

A

From Complete Dilation to Delivery

41
Q

What is the 3rd Stage of Labor?

A

From Infant Delivery to Placenta Delivery

42
Q

What is happening here?

A

Head Compression

43
Q

What is happening here?

A

UteroPlacental Insufficency

Compression of Vessels

44
Q

What is happening here?

A

Umbilical Cord Compression

45
Q

What is the most common cause of Materal Palsy?

A

Cephalopelvic Disproportion - causes lumbosacral trunk compression

46
Q

What are the complications of Neuraxial Blocks?

A

Nerve Injury

Postdural Puncture Headache (PDPH)

High/Total Spinal Anesthesia

47
Q

What are the types of Nerve Injuries that can happen from Neuraxial Blocks?

A

Epidural Hematoma & Abscess

Chemical Nerve Injury

Needle Trauma

Positioning Injury

48
Q

What kind of patients get Epidural Hematomas?

A

Patients w/ Coagulopathy during block placement or catether removal

49
Q

What must the coags be for a patient with Pregnacy-Induced HTN to get a Neuraxial Block?

A

Platelet > 100K & Stable

Normal PT/PTT

IV Analgesia if on Heparin

50
Q

What are the Neuraxial Block guidelines for a patient on Heparin?

A
  • Avoid block for 24 hr if therapuetic
  • Avoid block for 12 hr if prophylactic
  • Remove Catheter 12 hr after last dose
  • Dont give Heparin until 2-4 hr after block placed
  • Avoid concurrent NSAIDs
  • Alter Dose or Monitor Anti-Xa
51
Q

What are the Signs and Symptoms of an Epidural Hematoma?

A

Leg Weakness

Incontinence

Back Pain

Get CT or MRI

Must be decompressed w/in 6 hrs

52
Q

What are some sources of an Epidural Abscess?

A

Colonization of Iodine Bottles or Epidural Catheters

53
Q

When would you see symptoms of an Epidural Abscess?

A

4-10 days

Pain & Loss of Fxn

54
Q

What is the Treatment for an Epidural Abscess?

A

Abx or Laminectomy w/in 6-12 hrs

55
Q

What are the Symptoms of an Epidural Abscess?

A

Back pain w/ Flexion

Fever

Meningitis-like Headache

Stiff Neck

Neuro Deficits

Osteomyelitis

56
Q

What makes the Epidural Space resistant to Toxicity?

A

Vascularity & Intact Membrane

57
Q

What are Transient Neurological Symptoms (TNS)?

A

Pain & Dysesthesia in butt & legs after Lidocaine Subarachnoid Block & Lithotomy Position

58
Q

How can Needle Trauma happen?

A

Pain from hitting cord w/ needle at the conus (T12-L3)

OK if withdrawn immediately

Dont do regionals on sleeping patients

59
Q

How can the Lithotomy position cause Nerve Injury

A

Compresses Common Peroneal, Femoral, and Obturator Nerves

Recovery from days to years depending on severity

60
Q

What is the onset and duration of Post-Dural Puncture/Spinal Headaches?

A

12- 48 hrs after dura puncture & lasts days to weeks

61
Q

How does a Post-Dural Puncture cause Headache?

A

Loss of CSF volume as little a 20cc

Intracranial Sagging & Stretching of Pain Tissues

Cerebral Vasodilation

62
Q

What are Post-Dural Puncture Headache Risk Factors?

A

Young

Big Sharp Needle

Hx of PDPH or Migraine

63
Q

What are Post-Dural Puncture Headache Risk Factors when using an Epidural Needle?

A

Little Experience

LOR Technique

Haste

64
Q

What is the chance of a Post-Dural Puncture Headache using a 16-18 ga. Epidural?

A

75-80%

65
Q

What is the chance of a Post-Dural Puncture Headache using a 22 ga. Quincke vs. a 25 ga. Quincke?

A

22 ga. : 30-50%

25 ga. : 8-10%

66
Q

What is the chance of a Post-Dura Puncture Headache using a 24 ga. Sprotte?

A

3-5 %

67
Q

What is the chance of a Post-Dura Puncture Headache using a 25 ga. Whitacre?

A

1-2 %

68
Q

What are the best type of needles to use to avoid Post-Dura Puncture Headaches?

A

Pencil Point needle w/ Side Hole

Pushes Dura Fibers instead of cutting

69
Q

What is the Hallmark of a Post-Dura Puncture Headache?

A

Continuous head pain when sitting or standing fully relieved by recumbence

70
Q

What is the most common cause of PeriOperative Headaches?

A

Caffeine Withdrawal

71
Q

What is a Pneumocephalus Headache?

A

Instant headache w/ short duration when air injects intrathecal

72
Q

What is a Cortical Vein Thrombosis Headache?

A

Throbbing head ache not relieved by bed rest w/ possible Seizure

73
Q

What should you look for if a Subarachnoid Hemorrhage is suspected?

A

Focal Neurological Deficits

74
Q

What are Arnold-Chiari related Subdural Hematomas?

A

CSF leak causes lower brainstem to move down causing headaches, focal neuro signs, and blood vessel tears causing a subdural hematoma

75
Q

What can happen if Post-Dura Puncture Headaches are left untreated?

A

Chronic Headache

Permanent Impairment

Convulsions

Coning & Brainstem Death

76
Q

What are the Non-Invasive Treatments for PDPH?

A

Bed Rest

IV Fluids

Abdominal Binder

Pain Meds

Cerebral Vasoconstrictors

ACTH

77
Q

What is the Definitive Treatment for PDPH?

A

Epidural Blood Patch - Inject pt’s own blood into epidural space

Inject slowly until headache stops

Repeat blood patches increase success to 90%

78
Q

What are the risks for Epidural Blood Patches?

A

Same as epidural, but with more chance of backache

79
Q

How are Prophylactic Epidural Blood Patches given?

A

Thru Epidural Catheter

May result in Total Spinal

80
Q

How do Epidural Blood Patches work?

A

Clotting factors in blood seal dura hole and compresses CSF

81
Q

What are signs of a High or Total Spinal Anesthesia?

A

Hypotension

Dyspnea

Aphonia - Cant Speak

82
Q

What are some causes of a High or Total Spinal Anesthesia?

A

Migrated Epidural Catheter

Unrecognized Dural Puncture

Subarachnoid Block (SAB) after failed Epidural

83
Q

What should be done once a Total Spinal is recognized?

A
  • Left Uterine Displacement or Trendelenburg Position
  • Early Resuscitation, Ventilation, and Circulatory Support
  • Give Epinephrine
  • Give Narcan (For Opioid)
  • Monitor Mom & Baby Closely
  • Maintain Sedation
84
Q

What might be the cause of Hypoxia, Pulmonary Edema, and Bronchospams for a Pregnant Patient?

A

Aspiration

85
Q

What are ways to prevent Aspiration in the Pregnant Patient?

A

Cricoid Pressure

Fasting

Sodium Citrate

H2 Blockers

Reglan

86
Q

What should be done if the Pregnant pt aspirates?

A

Intubate & Positive Pressure Ventilation

Use necessary amt of O2

Suction

Rigid Bronchoscopy

Summer 2020 - APA Foundations 2 - OB (4 decks)

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