Obstetric Anesthesia 3
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Questions and Answers

Why is it recommended to administer metoclopramide and sodium citrate before induction in pregnant patients?

  • To promote maternal analgesia
  • To prevent hypotension during anesthesia
  • To reduce the risk of aspiration pneumonitis (correct)
  • To enhance uterine contractions

    • Which vascular changes occur during pregnancy to accommodate increased cardiac output?

  • Decreased pulmonary vascular resistance (correct)
  • Increased afterload
  • Increased systemic vascular resistance
  • Decreased venous capacitance

    • Which coagulation factor decreases during pregnancy?

  • Factor VII
  • Factor X
  • Protein S (correct)
  • Factor XII

    • What increases the risk of thromboembolism in postpartum patients?

    <p>Hypercoagulable state and venous stasis</p> Signup and view all the answers

    What cardiac auscultation finding is commonly observed in pregnant patients?

    <p>Benign 2/6 systolic ejection murmur due to increased flow</p> Signup and view all the answers

    Why is functional residual capacity (FRC) decreased in pregnancy?

    <p>Diaphragmatic elevation by the gravid uterus</p> Signup and view all the answers

    Which physiological mechanism allows for oxygen transfer from maternal to fetal circulation?

    <p>Maternal rightward oxyhemoglobin dissociation curve and fetal leftward shift</p> Signup and view all the answers

    What structural change in the heart is commonly seen in pregnant patients?

    <p>Leftward displacement of the heart with left ventricular hypertrophy</p> Signup and view all the answers

    What is the primary function of the intervillous space in the placenta?

    <p>To supply oxygen and nutrients to the fetus</p> Signup and view all the answers

    Which fetal shunt allows oxygenated blood to bypass the lungs?

    <p>Ductus arteriosus</p> Signup and view all the answers

    Why is placental drug transfer reduced for neuromuscular blocking agents?

    <p>Their high ionization and poor lipid solubility</p> Signup and view all the answers

    Which medication is safest for anticoagulation in a pregnant patient with an artificial heart valve?

    <p>Unfractionated heparin at term</p> Signup and view all the answers

    Why are pregnant patients considered at higher risk of difficult airway management?

    <p>Engorgement and edema of the upper airway</p> Signup and view all the answers

    Why does aortocaval compression lead to maternal hypotension?

    <p>Reduced venous return and cardiac preload</p> Signup and view all the answers

    What is the primary advantage of adding epinephrine to local anesthetics for neuraxial analgesia?

    <p>Reduced systemic absorption and prolonged duration</p> Signup and view all the answers

    Which type of drug is least likely to cross the placenta?

    <p>Large molecular weight drugs like NDNMBs</p> Signup and view all the answers

    How does pregnancy affect the epidural space and neuraxial anesthesia?

    <p>Engorgement of epidural veins reduces available space for local anesthetic</p> Signup and view all the answers

    What is the recommended treatment for Type 2 von Willebrand disease during labor?

    <p>DDAVP administration</p> Signup and view all the answers

    Why is MAC reduced in pregnant patients?

    <p>Hormonal changes and reduced cerebrospinal fluid volume</p> Signup and view all the answers

    What distinguishes uterine rupture from uterine atony?

    <p>Uterine rupture presents with fetal bradycardia and loss of station, while atony involves a soft, boggy uterus.</p> Signup and view all the answers

    Which is a characteristic finding in amniotic fluid embolism?

    <p>Progressive hypoxemia and disseminated intravascular coagulation (DIC)</p> Signup and view all the answers

    What is unique about the WBC count during pregnancy?

    <p>Leukocytosis is common</p> Signup and view all the answers

    What is the most significant factor in causing increased CO in the pregnant patient?

    <p>Increase in SV more than HR</p> Signup and view all the answers

    How much does CO increase during pregnancy?

    <p>40-50%</p> Signup and view all the answers

    When does the largest increase in CO occur?

    <p>80-100% increase immediately postpartum</p> Signup and view all the answers

    What is the compensation for aortocaval syndrome?

    <p>Increased peripheral SNS activity to increase SVR and BP</p> Signup and view all the answers

    What puts pregnant patients at risk for gallbladder disease?

    <p>Incomplete gallbladder emptying</p> Signup and view all the answers

    What is uterine blood flow directly proportional to?

    <p>Maternal cardiac output</p> Signup and view all the answers

    What is uterine blood flow indirectly proportional to?

    <p>Uterine vascular resistance</p> Signup and view all the answers

    What is the purpose behind increased plasma volume in pregnancy?

    <p>To compensate for EBL during childbirth</p> Signup and view all the answers

    What condition is associated with fetal acidosis?

    <p>Prolonged maternal hypotension</p> Signup and view all the answers

    What lung volumes increase during pregnancy?

    <p>Tidal volume, inspiratory capacity, inspiratory reserve volume</p> Signup and view all the answers

    What is the effect of pregnancy on the renal system?

    <p>Increased RBF, GFR, and decreased tubular reabsorption of protein and glucose</p> Signup and view all the answers

    What does the majority of uterine blood flow perfuse?

    <p>The intervillous space in the placenta</p> Signup and view all the answers

    Why is the first pass effect significant in the fetus?

    <p>Most umbilical venous blood passes through the liver</p> Signup and view all the answers

    What medications easily cross the placenta?

    <p>Volatile anesthetics, benzodiazepines, local anesthetics, opioids</p> Signup and view all the answers

    What is a normal fetal HR?

    <p>110-160 bpm</p> Signup and view all the answers

    What is the Ferguson reflex?

    <p>Dense blockade removing the maternal urge to push</p> Signup and view all the answers

    What is the cause of ineffective pushing?

    <p>Motor weakness secondary to a dense block</p> Signup and view all the answers

    What are the desired dermatomes for coverage in epidural anesthesia?

    <p>T10-L1 and caudally to S2-S4</p> Signup and view all the answers

    How should local anesthetics (LA) be administered?

    <p>In 5mL increments</p> Signup and view all the answers

    What is a complication associated with a combined spinal-epidural (CSE)?

    <p>Fetal bradycardia and maternal pruritus</p> Signup and view all the answers

    What local anesthetics (LA) are typically used for labor epidurals?

    <p>Bupivacaine and ropivacaine</p> Signup and view all the answers

    What local anesthetics (LA) are typically used for c-sections?

    <p>Lidocaine and 2-chloroprocaine</p> Signup and view all the answers

    What cranial nerve is most affected by post-dural puncture headache (PDPH)?

    <p>Abducens nerve (CN VI)</p> Signup and view all the answers

    What local anesthetics are associated with transient neurologic symptoms (TNS) and cauda equina syndrome?

    <p>Lidocaine and 2-chloroprocaine</p> Signup and view all the answers

    What complications are associated with volatile anesthetics in obstetric patients?

    <p>High doses cause uterine atony and blood loss</p> Signup and view all the answers

    At what minimum alveolar concentration (MAC) is there no impaired oxytocin response?

    <p>MAC &lt; 0.75</p> Signup and view all the answers

    By what mechanism are uterine contractions spared from the effects of neuromuscular blocking drugs (NMBD)?

    <p>Uterus is smooth muscle and is not affected by NMBDs</p> Signup and view all the answers

    When are induction medications administered during general anesthesia (GA) for an obstetric patient?

    <p>When the patient is draped and the surgeon is ready to make the incision</p> Signup and view all the answers

    What is gestational hypertension?

    <p>SBP &gt; 140 or DBP &gt; 90 after 20 weeks of pregnancy</p> Signup and view all the answers

    What is pre-eclampsia?

    <p>Gestational hypertension with proteinuria or protein/creatinine ratio of 0.3</p> Signup and view all the answers

    What is severe pre-eclampsia?

    <p>Gestational hypertension with thrombocytopenia, impaired liver function, progressive renal insufficiency, pulmonary edema, and visual abnormalities</p> Signup and view all the answers

    What is true about the pregnant patient with multiple sclerosis (MS)?

    <p>Pregnancy is associated with improvement in symptoms but worsening symptoms postpartum</p> Signup and view all the answers

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