Spinal Anesthesia vs. Epidural Anesthesia Quiz

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Questions and Answers

Which of the following is NOT a potential side effect of spinal anesthesia?

Respiratory depression (correct)

Shivering

Hypotension

Urinary retention

What is the purpose of administering an antacid prior to general anesthesia?

To induce unconsciousness more quickly

To neutralize stomach contents and reduce the risk of aspiration (correct)

To increase the patient's blood pressure

To enhance the effects of the anesthetic agents

What is the primary difference between spinal anesthesia and epidural anesthesia?

Spinal anesthesia is more effective for pain relief than epidural anesthesia

Spinal anesthesia is administered through a larger needle than epidural anesthesia

Spinal anesthesia is less invasive than epidural anesthesia

Spinal anesthesia is more intense and shorter-acting than epidural anesthesia (correct)

Which of the following is a contraindication for regional anesthesia (e.g., epidural or spinal)?

Active bleeding Signup and view all the answers

What is the purpose of the left uterine tilt during regional anesthesia?

To prevent hypotension by reducing aortocaval compression Signup and view all the answers

Which of the following is a key consideration when administering epidural or spinal anesthesia?

Ensuring the patient has a patent IV and IV bolus prepared Signup and view all the answers

What is a potential side effect of epidural or spinal anesthesia?

Respiratory depression Signup and view all the answers

What is the primary effect of systemic analgesia using IV narcotics?

Inhibits transmission of pain impulses Signup and view all the answers

Which of the following is a consideration when administering nitrous oxide as a systemic analgesia?

Both a and b Signup and view all the answers

What is the primary purpose of placing a urinary catheter when administering epidural or spinal anesthesia?

To prevent urinary retention Signup and view all the answers

What is the primary mechanism of action for systemic analgesia using IV narcotics?

Inhibits transmission of pain impulses Signup and view all the answers

Which statement about epidural anesthesia is correct?

It increases the risk of decreased respiratory status in the neonate as a short-term effect. Signup and view all the answers

Which of the following is a potential cause of respiratory depression in the neonate?

Sedatives and controlled pain medications (narcotics) Signup and view all the answers

What is the reversal agent for respiratory depression caused by narcotics in the neonate?

Naloxone (Narcan) Signup and view all the answers

Which of the following is a potential cause of a low APGAR score in the neonate?

Sedatives (benzodiazepines, H1 antagonists, barbiturates) Signup and view all the answers

Which of the following is a potential cause of molding of the newborn's head?

All of the above Signup and view all the answers

What is the recommended practice for umbilical cord clamping?

Delayed clamping, which allows 80-100 ml of additional blood to transfer to the baby Signup and view all the answers

Study Notes

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)

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Description

Test your knowledge on the differences between spinal and epidural anesthesia, including administration techniques, effects, and risks. Learn about repositioning techniques, solution settling time, and the risks associated with general anesthesia. Perfect for medical students, anesthesiologists, and healthcare professionals.