Parturient Surgery & Coexisting Disease - Quiz 3 Flashcards Preview

Summer 2020 - APA Foundations 2 - OB > Parturient Surgery & Coexisting Disease - Quiz 3 > Flashcards

Flashcards in Parturient Surgery & Coexisting Disease - Quiz 3 Deck (79)
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1

What are indications for a C-Section?

Failure to Progress

Fetal Distress

Malpresentation

Previous C/S

Mom's or Baby's Condition making Vaginal Delivery Unsafe

 

2

What is Local Infiltration?

Surgeon places Local

Rare and in Extreme Cases

Midline Incision w/ No Uteral Exteriorization

Supplements Regional

3

What is the most common type of Anesthesia for C-Sections?

Regional

Safer than General

Epidural Cath already in

Less Baby Depression

Mom can witness birth

4

What are indications for General Anesthesia for a C-Section?

Severe Fetal Distress

No time for block

Epidural Catheter Nonfunction

Inadequate Regional

Patient Refusal of Block

5

While under General, what should be avoided in the Parturient?

Hypotension

Hypoxia

Acidosis

Hyperventilation

6

How does General Anesthesia affect the baby's Apgar?

Lower @ 1 Minute

Same @ 5 Minutes

7

What should be done for a Parturient who has a difficult airway?

Early Induction of Epidural Analgesia

&

Consider Awake Fiberoptic Intubation

8

What are some Aspiration Prophylaxis meds?

  • Antacid - Sodium Citrate - Lasts 15 min & give to all
  • Ranitidine (Zantac) - H2 blocker
  • Reglan - decrease gastric volume, antiemetic, & inhibited by opioids
  • NPO x 6 hrs

9

Since parturients have Increased O2 consumption & Decreased FRC, what is critically important before Induction?

Preoxygenate & Denitrogenate w/ 100% O2 x 3 minutes

10

What is the Induction dose for Propofol?

2 - 2.8 mg/kg

Crosses placenta

11

Which Induction agent is useful for a Hemorrhaging Parturient?

Ketamine 1 - 1.5 mg/kg

Causes HTN & Dysphoria

12

Which inductions meds are NOT normally used for induction in the Parturient?

Versed - more neonatal depression than other meds

Etomidate - Adrenal supression of baby

N2O - Interferes w/ B12 Metabolism

13

Why are all NMBs safe for the Parturient?

Hydrophillic charged = little placental transfer

Atypical Pseudocholinesterse = paralyzed baby

14

How is Anesthesia maintained During & After delivery under General?

  • Before Delivery:
  • 50% N20 + 2/3 MAC before delivery
  • 1.2 MAC + 2-3 mcg/kg Fentanyl
  • After Delivery
  • N2O + 0.5 MAC + Versed

15

How does General vs. Regional affect Neonatal Depression?

No difference

Only the time from Uterine Incision to Delivery matters d/t Uterine Artery Spasm

16

What are the Advantages of Epidurals for C-Sections?

Tailored Dose

Prolong block for longer procedures

Post-Op Pain Control

Hemodynamic Stability

17

What are Disadvantages to Epidurals for C-Sections?

Contraindications

Block not as good as Spinal

Still may need General for Surgery

18

What is the highest cause of death associated w/ Regionals for C-Sections?

LA Toxicity, then High Spinals

19

What are the CV effects of a High Block?

Sympathectomy of Lower Extremity & Splanchnic Beds

↓Venous Return

↓BP

↓HR

↓Contractility

20

What are the Pulmonary Effects of Epidurals?

Inspiration: None

Expiration: Low Pressures & Flows = Feeling of Dyspnea

Reassure Patient

21

What is the Ideal Height of an Epidural Block for a C-Section?

T4 - T8

22

How should pain be managed w/ an Epidural before a C-Section Incision?

Fentanyl 100 - 150 mcg

23

How should breakthrough pain be managed during a C-Section?

5cc Local Bolus

Fentanyl

N2O

Ketamine 10mg

Local Infiltrate by Surgeon

Convert to GA

24

Why are Spinals sometimes used over Epidurals for C-Sections?

Dense block w/ single shot

Defined Endpoint: CSF Flow = Good

No Risk for Intravascular Injection

Easy & No Catheter

25

What are Disadvantages of Spinals vs. Epidurals for C-Sections?

Finite - cant give more

PDPH risk

Total Spine Risk

Maternal Hypotension

26

Laboring women have less hypotension w/ Spinals than Non-Laboring women: True or False?

True

 

27

How effective is Prehydration in the Parturient w/ preventing Hypotension?

Not effective - does not stay intravascular long + ANP increase causes diuresis

28

What is the drug of choice in treating Hypotension in the Parturient?

Phenylephrine

&

Also Ephedrine, but increases risk of fetal acidosis

29

What are some considerations w/ using Tetracaine?

Slow Onset

Long Duration

Unreliable

30

What are some considerations w/ using Lidocaine?

Short Acting

&

Neuro Symptoms

31

What are some considerations w/ using Bupivacaine?

Best Choice

Fast Onset

Intermediate Duration

32

How much Pitocin should be given after C-Section Delivery?

20 units of Pitocin in 1L Bag

or

30 units of Pitocin in 500cc Bag

33

What are the risks to the fetus during Non-OB surgeries in the Parturient?

Effect of Disease

Fetal Development d/t Anesthetic Agents

Uterine Blood Flow

Preterm Labor

Abortion

34

How does Pregnancy affect Anesthesia?

↑Sensitivities to Neuraxial Agents

↓MAC

↓Plasma Cholinesterase

↓Protein Binding

35

Which drug was shown to have teratogenic effects in rats?

N2O

Other gases not teratogenic in humans

36

When is it safe for patients to have elective surgery after giving birth?

6 weeks after delivery

37

Hyperthyroidism causes the Myocardium to be sensitive to __________

Hyperthyroidism causes the Myocardium to be sensitive to catecholamines

38

What are the Anesthetic considerations for caring for a Parturient w/ Hyperthyroidism?

May be on Propranolol which exacerbates Hypotension from Subarachnoid Block

&

Titrate pressors carefully - more sensitive

39

What can Pheochromocytoma look like particularly in the Parturient?

Preeclampsia

Epidural Preferred

DONT Beta-Block before Alpha Blocking first

40

How does pregnancy affect Bronchial Asthma?

May improve d/t Bronchodilation

Give Methylxanthines, Steroids, B-Adrenergics

Prefer Epidural > Spinal > GA

41

What drugs should be avoided in Parturients w/ Bronchial Asthma?

General Anesthesia

H2 Blockers - Rinitidine, Cimetidine

Desflurane

42

What Induction meds should be used for parturients w/ Bronchial Asthma?

Ketamine

&

Atropine or Robinul

43

Paraplegic Parturients have Autonomic Hyperreflexia & Preterm Labor Risk, what are the symptoms?

Triggered by Skin Stimulation & Bladder/Uterus Distension

Pilomotor Erection

Sweating

Flushing

Severe HTN

Bradycardia

44

How is Autonomic Hyperreflexia prevented in the Paraplegic Parturient?

Early Epidural Analgesia preferred over SAB

Avoid Sux d/t Hyperkalemia Risk

45

What are the two presenting patterns of Multiple Sclerosis?

Exacerbating Remitting - abrupt attacks resolving over months

&

Chronic Progressive

46

What are symptoms of Multiple Sclerosis?

Loss of CNS Myelin

Weakness

Impaired Vision

Ataxia

Bladder/Bowel Dysfunction

Labile Emotions

47

How is Multiple Sclerosis treated?

No Cure

Immunosupression

48

How does pregnancy affect Multiple Sclerosis?

Slight Relapse Risk d/t stress, exhaustion, infection, and fever

No negative effects overall

49

What are concerns regarding Neuraxial blocks w/ Multiple Sclerosis?

Toxicity d/t Demyelinated Spinal Cord

Dont use > 0.25% Bupivacaine

50

What should be avoided in parturients w/ Multiple Sclerosis?

Avoid Sux - muscles already weak

&

Maintain normal temps

51

What is the main concern w/ Parturients who have Brain Tumors?

Brain Herniation & Death

Avoid Dural Puncture

Consider IV pain control, Lumbar & Pudendal Blocks, or GETA

52

What is Pseudotumor cerebri?

Benign Intracranial Hypertension unrelated to a mass

OK for Epidural/Spinal

53

What special considerations should you take for Parturients w/ Epilepsy?

None - Proceed as normal

54

What is the pathophysiology of Myasthenia Gravis?

Progressive muscle weakness

ACTH receptor destruction

Effects Women 3x > Men

Treat w/ Neostigmine or Edrophonium

55

How does pregnancy affect Myasthenia Gravis?

Exacerbation

Cholinergic Crisis - may need more Neostigmine

56

What meds are Contraindicated for Parturients w/ Myasthenia Gravis?

Some ABX's

Mag Sulfate

Propranolol

Quinidine

Beta-Adrenergerics - Ritodrine, Terbutaline

Lithium

Penicillamine

Quinine

57

How does Myathenia Gravis affect Anesthetic Management?

1/2 MAC

1/2 Intubation Doses

More sensitive to NMBs, Opioids, & Locals

58

What are symptoms of a Cholinergic crisis related to Myathenia Gravis?

Profound Muscle Weakness

Resp. Failure

Loss of Bowel/Bladder Function

Disorientation

Diplopia

59

What is used to treat a Cholinergic Crisis?

IV & IM Atropine

60

What is Sickle Cell Disease?

Recessive Gene Blood Disorder

RBCs are abnormal, rigid, sickle shaped - pain, viscosity, auto-amputation

Shortened Life Span

61

Which form of Sickle Cell Disease causes the most problems for Parturients?

Homozygous/Rare Sickle Cell (HgbSS/HgbSC) - severe anemia & preeclampsia

Heterozygous (HgbAS) - no problems

62

What factors may cause a Sickle Cell Crisis?

Hypoxia

Hypotension

Dehydration

Hypothermia

Acidosis

Tourniquet

63

What is the most common type of VonWillebrand Disease (vWF)?

Type 1 - Treat w/ DDAVP

DONT use DDAVP w/ Type 3 - worsens bleed

Relative contraidication to Neuraxial blocks

64

What is Factor V Leiden?

Factor V CANNOT be inactivated by Protein C = Hypercoagulability

65

How are parturients w/ Factor V Leiden managed?

  • Early pregnancy Lovenox, then Heparin
  • Prophylactic Heparin - Hold 12 hrs before block
  • Therapuetic Heparin - Hold 24 hrs before block
  • Evaluate Anti-Xa

66

What do Protein C & Protein S do?

Work w/ Factors Va & VIIIa to inhibit clot formation

67

What might Phospholipid & Cardiolipid Antibodies suggest?

Hypercoagulability

68

What causes Diffuse Inflammation in Lungs, Pericardium, Pleura, Sclera, and Subcutaneous nodular lesions?

Rheumatoid Arthritis

69

What are Anesthetic problems related to Rheumatoid Arthritis?

Difficult airway d/t ↓Neck Mobility & Hardened Arytenoids

Difficult Epidural/Spinal needle placement

Restrictive Lung Disease

70

What are the CV issues regarding Rheumatoid Arthritis?

Pericarditis

Valvulitis

CAD

MI

Stroke

Atypical Angina

71

What is Lupus?

Multisystem Inflammatory Disease d/t Auto-Antibodies against cell membrane

Effects Black, Asian, and Native American Women in childbearing years

72

What are problems with Maternal Opioid Addiction?

Difficult IV Access

Mom & Baby Withdrawal Symptoms

↑O2 Consumption

↑Preterm Labor & Low Birth Weight

↑Maternal Hypovolemia & Adrenal Insufficiency

73

What are the risks invovled w/ Maternal Alcohol Addiction?

Hemorrhage

Clotting Abnormalities

Cardiomyopathy

Neuropathy

↑Gastric Volume & Acidity

74

What are problems w/ Maternal Amphetamine Addiction?

↑MAC & Gas = Uterine Atony

&

Catecholamine Depletion

75

What does cocaine do to the parturient & baby?

Vasoconstricts - ↓UBF

Thrombocytopenia

HTN & Tachycardia

↑PTL

↑Congenital Abnormalities

Growth Retardation

Low Birth Weight

76

How does Cocaine affect Local Anesthetics?

↓Plasma Cholinesterase - prolongs NMB & LA

77

How does HIV affect Pregnancy?

No Effect, but can cause paralysis, ataxia, encephalitis, and coma

78

How can HIV cause a difficult airway?

Pharyngeal Lymphatic Hypertrophy

79

In parturients w/ Cardiac Disease, what can reverse a L -> R shunt & Cyanosis?

Hypotension - be careful w/ SAB's w/ these patients