Spinal Anesthesia vs. Epidural Anesthesia Quiz

Anesthesia and Pain Management

• Spinal anesthesia is more intense and shorter acting than epidural, with risks of hypotension, shivering, and urinary retention.
• The needle penetrates the dura covering the spinal cord, with less intense effect compared to epidural.
• Repositioning the patient with a left uterine tilt and head on a pillow is necessary, with a wait of at least one minute for the hyperbaric solution to settle.

General Anesthesia

• General anesthesia carries more risks than regional anesthesia due to the patient being induced into unconsciousness.
• It is used in emergencies such as c-sections or stat deliveries.
• Risks include fetal respiratory depression, maternal aspiration, and failure to establish a patent airway.
• Preparations include NPO, pre-oxygenation with 100% O2, administration of antacid, and IV line setup.
• Assistance with breastfeeding is necessary due to unconsciousness, and assessments for bleeding and cardiac disease are crucial.

Intrauterine Pressure Catheter (IUPC)

• IUPC measures contractions quantitatively.
• Frequency, duration, and intensity of uterine contractions can be identified from the strip.

Pharmacologic Pain Management

Systemic Analgesia: Nitrous Oxide

• Nitrous oxide is safe for pain relief, controlled, and self-administered by the patient.
• It is safe, inexpensive, and effective, with no effect on fetal heart rate or neonatal respiratory depression.
• Patients at risk for falls are contraindicated, and those with B12 deficiency (anemia, alcoholism, anorexia) should not use it.
• Assessment of vital signs for both mother and baby is necessary.

Systemic Analgesia: IV Narcotics

• IV narcotics inhibit transmission of pain impulses, but can cause respiratory depression, sedation, and hypotension.
• They can be reversed with Naloxone (Narcan).
• Effects include euphoria, relaxation, pain relief, and reduced anxiety.
• Monitoring of fetal heart rate and assessment of fetal withdrawal after delivery are necessary.

Epidural/Spinal Anesthesia

• Epidural anesthesia requires a patent IV and IV bolus preparation.
• Placement of monitors for vital signs and oxygen, and patient positioning in a sitting position with back exposed are necessary.
• Repositioning to semi-reclining with left uterine tilt, and placement of a urinary catheter are necessary.
• Epidural anesthesia can cause temporary or reversible loss of sensation, hypotension, pruritis, patchy block, or shivering.
• Cord compression can occur, requiring repositioning of the mother (L-side) to address variable decelerations.

Sedatives and Controlled Pain Medication

• Sedatives and controlled pain medication can cause respiratory depression in the baby.
• Cord sedatives (benzo, H1 antagonist, barbs) can lead to a low APGAR score for the baby.
• Narcotics (morphine, fentanyl) have a reversal agent, Naloxone (Narcan).

Umbilical Cord Assessment

• The RN notes the umbilical cord for 2 arteries, 1 vein, or 1 artery, 1 vein (associated with genitourinary abnormalities).
• Delayed cord clamping allows for 80-100 ml of additional blood to transfer to the baby, benefiting preterm babies.

Newborn Head Molding

• Possible causes of molding of the newborn's head include:
  • Unfirmed sutures that can overlap and "mold" into different shapes
  • Pressure from the vaginal canal during delivery
  • Congenital disorders
  • Cephalopelvic Disproportion (CPD) = Macrosomia (baby > 8 lbs and 13 oz)
  • Instruments (forceps and vacuum extractions)
  • Caput succedaneum = swelling and edema of newborn scalp

High-Risk Deliveries: Forceps and VBAC

• Criteria for a mother to undergo a vaginal birth after cesarean (VBAC) include:
  • (Not specified in the provided text)