Obstetric Anesthesia 3

Play an AI-generated podcast conversation about this lesson

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? select all that apply

Protein S (correct)

Factor XI (correct)

Factor XIII (correct)

antithrombin III (correct)

What increases the risk of thromboembolism in postpartum patients?

Hypercoagulable state and venous stasis Signup and view all the answers

What cardiac auscultation finding is commonly observed in pregnant patients?

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

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

Diaphragmatic elevation by the gravid uterus Signup and view all the answers

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

Maternal rightward oxyhemoglobin dissociation curve and fetal leftward shift Signup and view all the answers

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

Leftward displacement of the heart with left ventricular hypertrophy Signup and view all the answers

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

To supply oxygen and nutrients to the fetus Signup and view all the answers

Which fetal shunt allows oxygenated blood to bypass the lungs?

Ductus arteriosus Signup and view all the answers

Why is placental drug transfer reduced for neuromuscular blocking agents?

Their high ionization and poor lipid solubility Signup and view all the answers

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

Unfractionated heparin at term Signup and view all the answers

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

Engorgement and edema of the upper airway Signup and view all the answers

Why does aortocaval compression lead to maternal hypotension?

Reduced venous return and cardiac preload Signup and view all the answers

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

Reduced systemic absorption and prolonged duration Signup and view all the answers

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

Large molecular weight drugs like NDNMBs Signup and view all the answers

How does pregnancy affect the epidural space and neuraxial anesthesia?

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

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

DDAVP administration Signup and view all the answers

Why is MAC reduced in pregnant patients?

Hormonal changes and reduced cerebrospinal fluid volume Signup and view all the answers

What distinguishes uterine rupture from uterine atony?

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

Which is a characteristic finding in amniotic fluid embolism?

Progressive hypoxemia and disseminated intravascular coagulation (DIC) Signup and view all the answers

What is unique about the WBC count during pregnancy?

Leukocytosis is common Signup and view all the answers

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

Increase in SV more than HR Signup and view all the answers

How much does CO increase during pregnancy?

40-50% Signup and view all the answers

When does the largest increase in CO occur?

80-100% increase immediately postpartum Signup and view all the answers

What is the compensation for aortocaval syndrome?

Increased peripheral SNS activity to increase SVR and BP Signup and view all the answers

What puts pregnant patients at risk for gallbladder disease?

Incomplete gallbladder emptying Signup and view all the answers

What is uterine blood flow directly proportional to?

Maternal cardiac output Signup and view all the answers

What is uterine blood flow indirectly proportional to?

Uterine vascular resistance Signup and view all the answers

What is the purpose behind increased plasma volume in pregnancy?

To compensate for EBL during childbirth Signup and view all the answers

What condition is associated with fetal acidosis?

Prolonged maternal hypotension Signup and view all the answers

What lung volumes increase during pregnancy?

Tidal volume, inspiratory capacity, inspiratory reserve volume Signup and view all the answers

What is the effect of pregnancy on the renal system?

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

What does the majority of uterine blood flow perfuse?

The intervillous space in the placenta (80%) Signup and view all the answers

Why is the first pass effect significant in the fetus?

50% of umbilical venous blood passes through the liver Signup and view all the answers

What medications easily cross the placenta?

Volatile anesthetics, benzodiazepines, local anesthetics, opioids Signup and view all the answers

What is a normal fetal HR?

110-160 bpm Signup and view all the answers

What is the Ferguson reflex?

Dense blockade removing the maternal urge to push Signup and view all the answers

What is the cause of ineffective pushing?

Motor weakness secondary to a dense block Signup and view all the answers

What are the desired dermatomes for coverage in epidural anesthesia?

T10-L1 and caudally to S2-S4 Signup and view all the answers

How should local anesthetics (LA) be administered?

In 5mL increments Signup and view all the answers

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

Fetal bradycardia and maternal pruritus Signup and view all the answers

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

Bupivacaine and ropivacaine Signup and view all the answers

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

Lidocaine and 2-chloroprocaine Signup and view all the answers

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

Abducens nerve (CN VI) Signup and view all the answers

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

Lidocaine and 2-chloroprocaine Signup and view all the answers

What complications are associated with volatile anesthetics in obstetric patients?

High doses cause uterine atony and blood loss Signup and view all the answers

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

MAC < 0.75 Signup and view all the answers

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

Uterus is smooth muscle and is not affected by NMBDs Signup and view all the answers

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

When the patient is draped and the surgeon is ready to make the incision Signup and view all the answers

What is gestational hypertension?

SBP > 140 or DBP > 90 after 20 weeks of pregnancy Signup and view all the answers

What is pre-eclampsia?

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

What is severe pre-eclampsia?

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

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

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

Medications that DO NOT easily cross the placenta = He Is Going Nowhere Soon = heparin, insulin, glycopyrrolate, NDNMB, succinylcholine

True Signup and view all the answers