Obstetric Anesthesia & Complications - Quiz 1 Flashcards Preview

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

Flashcards in Obstetric Anesthesia & Complications - Quiz 1 Deck (86)
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1

What are the Neuro Changes of Pregnancy?

Decreased MAC, Epidural Space, and CSF

Engorged Epidural Veins

Increased LA Sensitivity

2

What are the Respiratory Changes of Pregnancy?

↑TV (40%)

↑RR (15%)

↑Minute Ventilation (50%)

↓PaCO2

3

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

↓FRC (20%)

↓Dead Space

↓Airway Resistance

4

What Respiratory changes helps delivery of oxygen to fetus?

Increase of P50 Hemoglobin from 27 to 30 mmHg

5

What happens to the Respiratory Mucosa during Pregnancy?

Congestion d/t Vasodilation

Mucosal Engorgement = ↑Mallampati

6

What makes the mother prone to hypoxia during pregnancy?

↓FRC & ↑O2 Consumption

Preoxygenate & RSI w/ Cricoid Pressure

7

Why should Hyperventilation be avoided in Pregnancy during Anesthesia?

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

8

What Intubation equipment should be available for Pregnant Patients?

Smaller ETT

Shorter Handle

Avoid Nasal Intubation

9

How is Oxygen Delivery optimized during Pregnancy?

↑Cardiac Output

Right HgbO2 Shift

↓PVR d/t Increased Progesterone

10

How is Plasma Volume affected by Pregnancy?

Increased Plasma Volume d/t Increased Renin

11

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

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

12

What are the CV changes during Pregnancy?

Blunted Adrenergic Response

Cardiac Hypertrophy

Heart Murmurs

↓Plasma Colloid Osmotic Pressure

13

What is Supine Hypotension Syndrome?

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

14

What is the best position for Supine Hypotension Syndrome?

Left Lateral Uterine Tilt

15

How does the blood change in a pregnant patient?

Depressed Cell-Mediated Immunity

Hypercoagulation

PT/PTT decreases by 20%

16

Which Coagulation Factors are Increased during Pregnancy?

1, 7, 8, 9, 10, 12

17

Which Coagulation Factors are Decreased during Pregnancy?

11 & 13

18

Which Coagulation Factors are uneffected by Pregnancy?

2 & 5

19

What are the Renal Changes during Pregnancy?

↑Blood Flow & Filtration

↓BUN & Creat

Mild Glycosuria & Proteinuria

20

How does Pregnacy affect the Gastroesophageal Sphincter?

Reduced Competence & Tone

21

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

Increased Acid Secretion & Gastric Fluid

22

How is the Gallbladder affected by Pregnancy?

Sluggish & Gallstones d/t decreased CCK

23

How is the Liver affected by Pregnancy?

Decreased Pseudocholinesterase

(No effect on Sux Duration)

24

How does Pregnancy affect Blood Glucose?

Insulin Resistance = ↑Blood Glucose transfer to Fetus

25

What are the methods of transfer accross the Placenta?

Diffusion

Bulk Flow

Active Transport

Pinocytosis

Breaks

26

How long can the Fetus live without Oxygen?

10 minutes

27

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

Maternal Uterine Blood Flow vs. Fetal Umbilical Blood Flow

28

How much Oxygen is stored and consumed by the Fetus?

Stored O2: 42 mL

Consumed O2: 21 mL/min

29

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

Mom: Right HgbO2 Shift

Fetus: Left HgbO2 Shift & More Hgb

 

30

How is CO2 transfered across the Placenta?

Simple Diffusion

Fetal Hgb has lower CO2 affinity than Mom

31

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

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

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

32

What factors affect Uterine Blood Flow (UBF)?

BP

Uterine Vasoconstriction

Uterine Contractions

33

What anesthetic agents and drugs can decrease Uterine Blood flow?

Thiopental

Propofol

Gases > 1 MAC

34

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

Little to No Effect

35

How does high serum Local Anesthetics affect the Uterus?

Uterine Vasoconstriction, but Neuraxial Analgesia can reduce Vasoconstriction

36

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

Oxygen filling lungs ↓Pulm. Vascular Resistance

↑LAP closes Foramen Ovale

↑Oxygen Tension closes Ductus

37

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

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

38

When does normal Labor begin?

40 +/- 2 weeks after LMP

39

What happens in the 1st Stage of Labor?

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

40

When is the 2nd Stage of Labor?

From Complete Dilation to Delivery

41

What is the 3rd Stage of Labor?

From Infant Delivery to Placenta Delivery

42

What is happening here?

Head Compression

43

What is happening here?

UteroPlacental Insufficency

Compression of Vessels

44

What is happening here?

Umbilical Cord Compression

45

What is the most common cause of Materal Palsy?

Cephalopelvic Disproportion - causes lumbosacral trunk compression

46

What are the complications of Neuraxial Blocks?

Nerve Injury

Postdural Puncture Headache (PDPH)

High/Total Spinal Anesthesia

47

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

Epidural Hematoma & Abscess

Chemical Nerve Injury

Needle Trauma

Positioning Injury

48

What kind of patients get Epidural Hematomas?

Patients w/ Coagulopathy during block placement or catether removal

49

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

Platelet > 100K & Stable

Normal PT/PTT

IV Analgesia if on Heparin

50

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

  • 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

What are the Signs and Symptoms of an Epidural Hematoma?

Leg Weakness

Incontinence

Back Pain

Get CT or MRI

Must be decompressed w/in 6 hrs

52

What are some sources of an Epidural Abscess?

Colonization of Iodine Bottles or Epidural Catheters

53

When would you see symptoms of an Epidural Abscess?

4-10 days

Pain & Loss of Fxn

54

What is the Treatment for an Epidural Abscess?

Abx or Laminectomy w/in 6-12 hrs

55

What are the Symptoms of an Epidural Abscess?

Back pain w/ Flexion

Fever

Meningitis-like Headache

Stiff Neck

Neuro Deficits

Osteomyelitis

56

What makes the Epidural Space resistant to Toxicity?

Vascularity & Intact Membrane

57

What are Transient Neurological Symptoms (TNS)?

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

58

How can Needle Trauma happen?

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

OK if withdrawn immediately

Dont do regionals on sleeping patients

59

How can the Lithotomy position cause Nerve Injury

Compresses Common Peroneal, Femoral, and Obturator Nerves

Recovery from days to years depending on severity

60

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

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

61

How does a Post-Dural Puncture cause Headache?

Loss of CSF volume as little a 20cc

Intracranial Sagging & Stretching of Pain Tissues

Cerebral Vasodilation

62

What are Post-Dural Puncture Headache Risk Factors?

Young

Big Sharp Needle

Hx of PDPH or Migraine

63

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

Little Experience

LOR Technique

Haste

 

64

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

75-80%

65

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

22 ga. : 30-50%

25 ga. : 8-10%

66

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

3-5 %

67

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

1-2 %

68

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

Pencil Point needle w/ Side Hole

Pushes Dura Fibers instead of cutting

69

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

Continuous head pain when sitting or standing fully relieved by recumbence

70

What is the most common cause of PeriOperative Headaches?

Caffeine Withdrawal

71

What is a Pneumocephalus Headache?

Instant headache w/ short duration when air injects intrathecal

72

What is a Cortical Vein Thrombosis Headache?

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

73

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

Focal Neurological Deficits

74

What are Arnold-Chiari related Subdural Hematomas?

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

75

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

Chronic Headache

Permanent Impairment

Convulsions

Coning & Brainstem Death

76

What are the Non-Invasive Treatments for PDPH?

Bed Rest

IV Fluids

Abdominal Binder

Pain Meds

Cerebral Vasoconstrictors

ACTH

77

What is the Definitive Treatment for PDPH?

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

Inject slowly until headache stops

Repeat blood patches increase success to 90%

78

What are the risks for Epidural Blood Patches?

Same as epidural, but with more chance of backache

79

How are Prophylactic Epidural Blood Patches given?

Thru Epidural Catheter

May result in Total Spinal

80

How do Epidural Blood Patches work?

Clotting factors in blood seal dura hole and compresses CSF

81

What are signs of a High or Total Spinal Anesthesia?

Hypotension

Dyspnea

Aphonia - Cant Speak

82

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

Migrated Epidural Catheter

Unrecognized Dural Puncture

Subarachnoid Block (SAB) after failed Epidural

83

What should be done once a Total Spinal is recognized?

  • 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

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

Aspiration

85

What are ways to prevent Aspiration in the Pregnant Patient?

Cricoid Pressure

Fasting

Sodium Citrate

H2 Blockers

Reglan

86

What should be done if the Pregnant pt aspirates?

Intubate & Positive Pressure Ventilation

Use necessary amt of O2

Suction

Rigid Bronchoscopy