Obstetrics 4

Question 1

_______ is indicated for induction or augmentation of labor, stimulating uterine contraction (c-section), and combating uterine hypotonia and hemorrhage

Answer 1

Oxytocin

Question 2

Side effects of oxytocin include

Answer 2

water retention, hyponatremia, hypotension, reflex tachycardia, and coronary vasoconstriction

Question 3

Rapid IV administration of oxytocin can cause

Answer 3

cardiovascular collapse

Question 4

The second-line uterotonic is typically

Answer 4

Methergine

Question 5

Methergine is administered

Answer 5

IM

Question 6

If methergine is given IV it can cause

Answer 6

significant vasoconstriction, hypertension, and cerebral hemorrhage

Question 7

Prostaglandin F2 side effects include

Answer 7

N/V, diarrhea, hypotension, and bronchospasm

Question 8

The dose of methergine is

Answer 8

0.2 mg IM

Question 9

The half-life of methergine is

Answer 9

2 hours

Question 10

Methergine is metabolized

Answer 10

hepatically

Question 11

The third line uterotonic is

Answer 11

Prostaglandin F2 (hemabate or carboprost)

Question 12

The dose of prostaglandin F2 is

Answer 12

250 mcg IM or injected into the uterus

Question 13

During a C-section, oxytocin is administered

Answer 13

after the delivery of the placent

Question 14

The half-life of oxytocin is

Answer 14

4-17 minutes

Question 15

Oxytocin is metabolized

Answer 15

hepatically

Question 16

Oxytocin is primarily synthesized in the

Answer 16

paraventricular nuclei of the hypothalamus

Question 17

Oxytocin is stored in and released from

Answer 17

the posterior pituitary gland

Question 18

Endogenous oxytocin is released following stimulation of

Answer 18

the cervix, vagina, and breasts

Question 19

____ is the synthetic equivalent of oxytocin

Answer 19

Pitocin

Question 20

Anesthetic implications for cesarean section under general anesthesia include:
a. administration of a dopamine agonist
b. prolonged neonatal respiratory depression
c. increased MAC
d. rapid sequence induction

Answer 20

D.

Question 21

What situations would be appropriate for a general anesthetic for a Cesarean delivery?

Answer 21

maternal hemorrhage
fetal distress
coagulopathy
patient refusal of regional anesthesia
contraindications to regional anesthesia

Question 22

In the obstetric population, mortality is ________ with a general anesthetic

Answer 22

17 x higher

Question 23

When choosing a general anesthetic for a parturient, plan for

Answer 23

a difficult intubation

Question 24

Aspiration prophylaxis for a C-section for a general anesthetic is

Answer 24

sodium citrate
H2 receptor antagonist
gastrokinetic agent

Question 25

_________ should be used to minimize aortocaval compression

Answer 25

Left uterine displacement

Question 26

When performing general anesthesia for C-section, allow the surgical team to

Answer 26

prep and drape the patient before induction

Question 27

For general anesthesia for a C-section, preoxygenate for

Answer 27

3-5 minutes or give four vital capacity breaths

Question 28

Describe the HELP position for the general anesthetic C-section patient.

Answer 28

Head elevated laryngoscopy position

Question 29

Emergent C-sections carry a high risk of

Answer 29

recall

Question 30

Volatile agents reduce

Answer 30

uterine contractility, but be sure to use enough agents to produce amnesia

Question 31

The risk of neonatal acidosis increases when the time between uterine incision and delivery

Answer 31

exceeds 3 minutes

Question 32

How should C-section patients be extubated?

Answer 32

fully awake! still considered a full stomach and is at risk for airway obstruction

Question 33

Sodium citrate is used to

Answer 33

neutralize gastric acid

Question 34

H2 receptor antagonist (ranitidine) is used to

Answer 34

reduce gastric acid secretion

Question 35

Gastrokinetic agents (metoclopramide) is used to

Answer 35

hasten gastric emptying and increase LES tone

Question 36

With succinylcholine, pregnancy reduces the risk of

Answer 36

myalgia

Question 37

Describe the induction doses of propofol, etomidate, and ketamine for the C-section general anesthetic patient.

Answer 37

propofol 2-2.5 mg/kg etomidate 0.3 mg/kg ketamine 1 mg/kg

Question 38

Consider the use of ________ & ______ after the baby is delivered for general anesthesia for C-section.

Answer 38

opioid and benzodiazepine

Question 39

Normal amniotic fluid volume is ______, so keep this in mind when assessing blood loss for C-section.

Answer 39

700 mL

Question 40

Describe the concentration of anesthetic gases to use for general anesthesia for a C-section

Answer 40

low concentration of volatile agent (0.8 MAC) + 50% nitrous oxide

Question 41

List the 3 benefits of a GA during a c-section.

Answer 41

speed of onset secure airway greater hemodynamic stability

Question 42

An obstetric patient at 33-weeks gestation requires a laparoscopic appendectomy. What drug presents the GREATEST risk to fetal well-being? A. ketorolac B. succinylcholine C. Propofol D. Morphine

Answer 42

A.- after the first trimester, NSAIDs can close the ductus arteriosus

Question 43

Approximately _____ of parturients undergo non-obstetric procedures involving anesthesia each year.

Answer 43

2%

Question 44

The most significant maternal risks for non-obstetric surgery during pregnancy include

Answer 44

difficult intubation & aspiration

Question 45

The best time for surgery for the pregnant patient is

Answer 45

ideally 2-6 weeks after delivery otherwise- second semester

Question 46

_______ is linked to congenital defects in animal studies, but many practitioners avoid _____ altogether during the first two trimesters.

Answer 46

Nitrous oxide

Question 47

The most significant fetal risks for non-obstetric surgery during pregnancy include

Answer 47

growth restriction low birth weight demise increased incidence of preterm labor

Question 48

The highest incidence of preterm labor in the non-obstetric parturient surgical patient is

Answer 48

intraabdominal and pelvic surgery

Question 49

Iatrogenic hyperventilation reduces

Answer 49

placental blood flow (risk of fetal asphyxia)

Question 50

Avoid ______ after the first trimester, as they potentially close the ductus arteriosus.

Answer 50

NSAIDs

Question 51

At approximately _______, pregnant patients are considered a "full stomach".

Answer 51

18-20 weeks gestation

Question 52

Teratogenicity can occur at any time during pregnancy, however, the risk is highest during

Answer 52

organogenesis (day 13-60)

Question 53

Normal maternal PaCo2 is

Answer 53

~30 mmHg

Question 54

Anesthesia and surgery do not increase the incidence of

Answer 54

congenital anomalies

Question 55

What drugs have a long track record of safety for the parturient patient?

Answer 55

opioids inhalational agents all muscle relaxants thiopental