OB Anesthesia (246 cards) – Flashcards
Unlock all answers in this set
Unlock answersquestion
PHYSIOLOGIC CHANGES OF PREGNANCY
answer
...
question
What is the most important anesthetic goal during the care of a pregnant patient?
answer
Avoidance of decreased uteroplacental blood flow.
question
What is the effect of pregnancy on MAC?
answer
Pregnancy decreases MAC by about 40%.
question
What is the effect of pregnancy on spinal and epidural dose requirements?
answer
Local anesthetic dose requirements are reduced because of 1) decreased volume of epidural and spinal space, and 2) increased sensitivity of nerves to block.
question
Pregnant patients demonstrate more rapid induction, emergence, and change in the depth of anesthesia because of...
answer
INCREASED MV:FRC RATIO
question
What is the normal PaCO2 in pregnancy?
answer
32 mmHg
question
What is the normal HCO3- in pregnancy?
answer
21 mEq/L
question
By how much is minute ventilation changed at term pregnancy?
answer
50% increase - due to increased tidal volume
question
Which two factors predispose the pregnant patient to the development of rapid hypoxemia upon development of apnea?
answer
1) Increased VO2 2) Decreased FRC
question
What is the common relationship between Closing Capacity and FRC in pregnant patients when supine? How often?
answer
Closing Capacity exceeds FRC in 50% of supine pregnant patients.
question
What is the effect of progesterone on the airway?
answer
Progesterone leads to decreased airway resistance.
question
What is the effect of pregnancy on vital capacity?
answer
Vital capacity is unchanged in pregnancy.
question
What accounts for the change in FRC in pregnancy?
answer
Decreased RV accounts for the decrease in FRC seen in pregnancy.
question
What happens to PaO2 in pregnancy? To what can this change be attributed?
answer
PaO2 increases in pregnancy. This can be accounted for by the decrease in PaCO2.
question
When is cardiac output greatest in the setting of pregnancy?
answer
Immediately postpartum (60 - 80% increase over the nonpregnant state)
question
What is the change in cardiac output observed during pregnancy?
answer
Cardiac output increases by 40% at term.
question
What happens to CVP and PA pressures in pregnancy?
answer
They are likely to remain unchanged.
question
What change is seen in cardiac output during labor?
answer
Labor increases CO by 45%.
question
When, after delivery, does cardiac output return to normal?
answer
2 weeks postpartum.
question
What happens to plasma volume and RBC mass during pregnancy?
answer
Plasma volume increases 40% Red cell volume increases 20%
question
What is considered true anemia during pregnancy?
answer
Hct < 33% OR Hb < 11 g/dL
question
What is typical blood loss during vaginal delivery?
answer
500 mL
question
What is typical blood loss during C-section?
answer
800 - 1000 mL
question
What is normal SVR?
answer
Normal SVR = 800 - 1200 dynes x sec / cm^5
question
What is normal PVR?
answer
Normal PVR < 250 dynes x sec / cm^5
question
What is normal CVP?
answer
About 5 mmHg
question
What is normal stroke volume?
answer
60 - 100 mL/beat
question
What is normal mixed venous O2 content?
answer
15 mL/dL
question
What happens to SVR during pregnancy?
answer
It decreases.
question
What happens to BP during pregnancy?
answer
First, BP should never rise above non-pregnant levels at any time. BP usually decreases during the 2nd trimester, but tends to return to normal during the 3re trimester.
question
What are the two principal GI changes associated with pregnancy?
answer
Cephalad displacement of the stomach Decreased LES tone
question
When do pregnant women exhibit delayed gastric emptying?
answer
During labor
question
What is the syndrome associated with chemical pneumonitis secondary to aspiration of gastric acid?
answer
Mendelson's Syndrome
question
What happens to renal function during pregnancy?
answer
Renal blood flow and GFR are both increased by about 50% during pregnancy.
question
What happens to serum creatinine levels during pregnancy?
answer
Serum creatinine is reduced
question
What happens to pseudocholinesterase levels in pregnancy? What about succinylcholine dosing?
answer
They are reduced. Succinylcholine effects, however, are not prolonged.
question
What happens to serum albumin during pregnancy?
answer
It is decreased, resulting in higher free blood levels of all drugs which rely on protein binding.
question
What happens to PT and PTT during pregnancy?
answer
They are unchanged.
question
UTEROPLACENTAL BLOOD FLOW
answer
...
question
What is normal uterine blood flow?
answer
500 - 700 mL/min
question
By how much must uterine blood flow decrease before fetal distress is detected?
answer
50%
question
What feature of the uteroplacental circulation is especially important in the management of uteroplacental blood flow?
answer
It is NOT autoregulated.
question
What is the umbilical artery/vein structure?
answer
Two umbilical arteries. One umbilical vein, which carries oxygenated blood to the fetus.
question
Where does uterine blood supply come from?
answer
Two uterine arteries.
question
What is the PO2 of umbilical venous blood? What is the SO2?
answer
30 mmHg; 70%
question
What is the PCO2 of umbilical venous blood?
answer
40 mmHg
question
What is the pH of umbilical venous blood?
answer
7.35
question
What is the PO2 of umbilical arterial blood (blood which has traveled through the fetus and returns to the placenta)? What is the SO2?
answer
20 mmHg; 40%
question
What is the PCO2 of umbilical arterial blood?
answer
50 mmHg
question
What is the pH of umbilical arterial blood?
answer
7.28
question
What is the impact of elevated uterine venous pressure?
answer
Increased uterine venous pressure reduces uterine perfusion pressure.
question
Under what circumstances does uterine venous pressure rise?
answer
IVC compression Placental abruption
question
What is the umbilical ABG at 60 minutes?
answer
7.30-7.35/30/60
question
What is the umbilical ABG at 24 hours?
answer
7.30-7.35/30/70
question
What is the effect of epinephrine on uterine blood flow?
answer
Epinephrine decreases uterine blood flow.
question
What are the determinants of transplacental diffusion of drugs?
answer
Concentration gradient Protein binding Molecular weight Lipid solubility Ionization Fetal pH
question
What are five important drugs which DO NOT CROSS the placenta?
answer
Heparin Insulin Glycopyrrolate Nondepolarizing NMBs Succinylcholine
question
What is the mnemonic for recalling the drugs which do not cross the placenta?
answer
"He Is Going Nowhere Soon."
question
What is the percent protein binding of lidocaine?
answer
50%
question
What is the percent protein binding of bupivacaine?
answer
95%
question
Why do nondepolarizers not cross the placenta?
answer
They are too large
question
Why does succinylcholine not cross the placenta?
answer
It is too highly ionized
question
TESTED POINT: What is the beneficial effect of fetal-to-maternal CO2 transfer?
answer
It enhances maternal-to-fetal oxygen transfer.
question
MEDICATIONS DURING LABOR
answer
...
question
Which four anesthetic drugs are "probably safe" during labor?
answer
Small doses of: Benzodiazepines Opioids Thiopental (4 mg/kg) Ketamine
question
Why is thiopental usually safe in labor?
answer
Thiopental is usually safe because the fetus is removed before peak serum concentrations reaches the placenta.
question
What are the stages of labor?
answer
1) Cervical dilation 2) Delivery of the fetus 3) Delivery of the placenta
question
Which nerves transmit pain in the first stage of labor?
answer
T10 - L1
question
Which nerves transmit pain in the second stage of labor?
answer
S2 - 4 (The Pudendal Nerve)
question
Which block can relieve the pain of the first stage of labor but not the second stage?
answer
Paracervical Block
question
Which block can relieve the pain of the second stage of labor but not the first stage?
answer
Pudendal Nerve Block
question
What is a major concern related to paracervical block?
answer
10 - 40% incidence of fetal bradycardia.
question
Which two blocks are not effective during the second stage of labor?
answer
Paracervical block Lumbar sympathetic block
question
Which crosses the placenta more effectively, bupivacaine or lidocaine?
answer
Lidocaine; it is less protein-bound than bupivacaine.
question
What is a risk of epidural test dose in the laboring patient?
answer
In the case of accidental intravenous injection, the epinephrine WILL decrease uterine blood flow. However, the benefit of the test dose is believed to outweigh the risk.
question
What are advantages of GA in the parturient?
answer
Controlled airway Absence of hypotension seen with regional
question
What are disadvantages of GA in the parturient?
answer
Risk of aspiration Risk of failed intubation
question
What dose of volatile agent can be administered without a decrease in uterine blood flow or depression of the fetus?
answer
2/3 MAC
question
What commonly-used drugs for epidural analgesia are NOT used for spinal?
answer
Chloroprocaine Lidocaine
question
What is the risk associated with chloroprocaine spinal? And lidocaine spinal?
answer
ADHESIVE ARACHNOIDITIS; TNS
question
What is the advantage of caudal anesthesia in the parturient?
answer
Excellent perineal anesthesia
question
What are the disadvantages of caudal anesthesia in the parturient?
answer
Accidental subarachnoid or IV injection, infection, injection into the fetus, and inability to raise the level of the block should C-section become necessary.
question
What is an appropriate medication and dose for caudal anesthesia in the parturient?
answer
10 - 12 mL of 0.25% bupivacaine
question
Which condition should be first on the differential diagnosis of hypotension after the first trimester of pregnancy?
answer
Aortocaval compression
question
What is the appropriate course for the treatment of hypotension in a pregnant patient?
answer
1) LUD 2) Fluids 3) Phenylephrine or Ephedrine
question
What are the two most common complications of regional for parturients?
answer
Accidental subarachnoid or IV injection.
question
What steps should be taken prior to induction of anesthesia in an emergency C-section?
answer
1) Sodium citrate 2) Placement of monitors 3) Eval fluid status 4) FINALLY... recheck fetus
question
What are five indications for C-section with GENERAL ANESTHESIA?
answer
Fetal distress Maternal hemorrhage Cephalopelvic disproportion Uterine dystocia Breech presentation
question
What is the most important factor determining fetal outcome following C-section?
answer
Time from uterine incision to delivery of the fetus
question
ABNORMAL PRESENTATION
answer
...
question
What are the different types of breech presentation?
answer
Frank Breech Complete Breech Incomplete Breech
question
What is a Frank Breech presentation?
answer
Frank Breech means the buttocks is presenting. Feet are against the face.
question
What is a Complete Breech presentation?
answer
Buttocks and feet both present.
question
What is an Incomplete Breech presentation?
answer
One or both feet are presenting.
question
What are the fetal risks associated with breech delivery? Maternal?
answer
Fetal risks include asphyxia due to cord compression and IVH due to trauma. Maternal risks include hemorrhage, infection, and retained placenta.
question
MULTIPLE GESTATIONS
answer
...
question
What is the maternal mortality associated with multiple gestations?
answer
2-3 fold elevated
question
What are the specific risks leading to elevated maternal mortality in association with multiple gestations?
answer
Anemia Hemorrhage Toxemia Prolonged labor
question
Multiple gestation is associated with increased incidence of...
answer
supine hypotension syndrome.
question
What are the risks associated with twin-twin transfusion?
answer
Twin A: CHF and polycythemia Twin B: Anemia and hypovolemia
question
What are the umbilical cord problems associated with multiple gestation?
answer
Occlusion Intertwining
question
What are the risks to the second and subsequent neonates following birth of the first baby?
answer
Second twin depression can occur, due to prolonged contractions and early placental separation.
question
How much longer is the labor in multiple gestations?
answer
It is not longer; labor is shorter with multiple gestations.
question
Which precautions should be undertaken prior to delivery of multiple gestations?
answer
1) Blood cross-matched 2) 2 IVs 3) MDs available for resuscitation
question
PREECLAMPSIA AND ECLAMPSIA
answer
...
question
What are the cardinal manifestations of preeclampsia?
answer
HTN Proteinuria Edema
question
In what population is preeclampsia most common?
answer
Primigravidas
question
What is the window for onset of preeclampsia?
answer
20 weeks gestation - 6 weeks postpartum
question
What is the diagnosis of preeclampsia?
answer
Two BPs of 140/90 or greater in the presence of proteinuria 2g/day
question
What is the diagnosis of severe preeclampsia?
answer
Two BPs of 160/110 or greater in the presence of proteinuria.
question
What do we call preeclampsia without proteinuria?
answer
Pregnancy-induced HTN
question
A woman with preeclampsia and abdominal pain should be suspected of having...
answer
HELLP Syndrome. Abdominal pain could be caused by hepatic inflammation.
question
What are complications of severe preeclampsia?
answer
CHF Pulmonary edema Renal failure DIC Eclampsia
question
Incidence of preeclampsia is greatest among mothers who undergo rapid uterine enlargement, such as...
answer
Diabetes Multiple gestations Polyhydramnios (also common in past Preeclampsia)
question
How should magnesium administration begin?
answer
Deliver a 4 g IV loading dose as a 20% solution.
question
Magnesium effects are VASST...
answer
Vasodilation Anticonvulsant Sedative Skeletal muscle relaxant Tocolytic
question
What are the two effects of magnesium on the skeletal muscle?
answer
1) Decreases ACh release 2) Decreases endplate sensitivity to ACh
question
What is the therapeutic level of magnesium?
answer
5 mEq/L
question
What is the range of magnesium over which EKG changes are seen?
answer
5 - 10 mEq/L
question
What is the range of magnesium over which loss of DTRs occurs?
answer
> 10 mEq/L
question
What is the concentration of magnesium at which respiratory paralysis is seen?
answer
15 mEq/L
question
What is the concentration of magnesium at which cardiac arrest is seen?
answer
20 mEq/L
question
What happens upon succinylcholine dosing in a patient with therapeutic magnesium level?
answer
Fasciculations are absent. Sux dose should be 50% of normal dose.
question
Why is captopril avoided in the treatment of HTN in pregnant women?
answer
Captopril has been associated with fetal death, IUGR, and renal problems.
question
What constitutes ideal anesthetic management of the patient with preeclampsia?
answer
Epidural is a great choice, unless emergent or extremely severe.
question
What should be done prior to placement of an epidural in a patient with severe preeclampsia?
answer
Check coags Give aspiration prophylaxis
question
What constitutes ideal anesthetic management of the patient with eclampsia?
answer
Secure the airway with thiopental and succinylcholine, then deliver the child.
question
What are 6 causes of maternal hemorrhage?
answer
Placental abruption Placenta previa Placenta accreta Placental retention Uterine atony Uterine rupture
question
What is the incidence of placenta previa? What is a known risk factor?
answer
0.1 - 1%. Increasing age is a risk factor.
question
What is the typical presentation of placenta previa? What should be the first step in management?
answer
Painless vaginal bleeding. The first step is to obtain an emergency sonogram.
question
What is a good choice for anesthetic in a parturient with severe and active bleeding?
answer
GA with ketamine.
question
Which cause of hemorrhage in the parturient is the leading cause of maternal mortality worldwide?
answer
Uterine atony.
question
What is the approach to non-obstetric surgery for pregnant patients, based on urgency?
answer
Elective surgery should be postponed until delivery, AFTER physiology returns to normal. Urgent surgery should be postponed until after the first trimester.
question
Why is the first trimester the riskiest time to undergo non-obstetric surgery? (two reasons)
answer
1) Organogenesis 2) Highest risk of miscarriage
question
Which monitors and preparations are necessary for non-obstetric surgery in the parturient?
answer
FHR monitoring after 20 weeks Uterine tocometry LUD after first trimester
question
What is the best approach to anesthetic medications for pregnant patients undergoing non-obstetric surgery?
answer
Opioids are great because they can reduce the need for volatile anesthetics, thereby attenuating BP reduction. Also, opioids are very useful for the pregnant patient with cardiac disease. BE SURE TO INFORM THE PEDIATRICIAN OF OPIOID DOSING IF DELIVERY IS TO BE PERFORMED.
question
Which drugs should be avoided in pregnant patients undergoing non-obstetric surgery?
answer
Midazolam and diazepam
question
Is nitrous oxide flammable?
answer
No, but it supports combustion.
question
What is the MAC of nitrous oxide?
answer
104%
question
What is diffusion hypoxia?
answer
When delivery of N2O is stopped, the high concentration in blood leads to rapid transfer to the alveoli, potentially diluting the O2 content of the alveolus. For this reason, delivery of a high concentration of O2 is indicated upon cessation of N2O delivery.
question
Why is it important to avoid hyperventilation in the pregnant patient during anesthesia?
answer
1) Left-shift of O2-Hb curve 2) Umbilical arterial constriction 3) May reduce venous return and, thereby, maternal CO.
question
What are the keys to anesthetic management (not including drugs) of the pregnant patient for non-obstetric surgery?
answer
Avoid hypoxemia Avoid hypotension Avoid hyperventilation Strongly consider regional Consider monitoring of PaCO2 rather than PETCO2 Have a plan of action if there is a persistent nonreassuring FHT.
question
Which is better for the prevention of maternal hypotension: ephedrine or phenylephrine? Why?
answer
Phenylephrine may be preferable because ephedrine is associated with lower umbilical arterial pH.
question
What about NMBs and reversal agents?
answer
Just be sure to administer reversal slowly. Glycopyrrolate does not cross the placenta.
question
What is the published risk of preterm labor related to non-obstetric surgery? When is it lowest?
answer
The risk appears to be around 22%, with lowest risk in the second trimester.
question
Is pregnancy a contraindication to ECT?
answer
NO.
question
When does FHR variability develop?
answer
Between weeks 25 - 27 of gestation. This is a reassuring sign of fetal well-being.
question
Which type of regional is not recommended for non-obstetric surgery in the pregnant patient?
answer
Paracervical block is not recommended. Bear in mind that most abdominal surgeries during pregnancy will require GA with definitive airway control.
question
What is the latest consensus related to the use of nitrous oxide in pregnant patients?
answer
Scientific evidence does NOT support avoidance of nitrous oxide during pregnancy, particularly after the 6th week of gestation. A cautious approach would restriction N2O to concentrations of 50% or less, and limit use in prolonged anesthetics.
question
What has been the concern related to the use of nitrous oxide in pregnant patients in the past?
answer
Nitrous has been shown to inhibit methionine synthetase. In past, there was concern that N2O would impair DNA synthesis in the fetus.
question
What are the guidelines regarding DC cardioversion during pregnancy?
answer
It is safe... little current reaches the fetus. FHR monitoring is indicated.
question
What management strategy should be considered if initial resuscitation efforts are ineffective following cardiorespiratory arrest of a pregnant patient?
answer
Consider C-section.
question
And don't forget...
answer
LEFT UTERINE DISPLACEMENT during resuscitation.
question
DRUGS AND UTERINE TONE
answer
...
question
Which drugs have minimal effect on uterine tone?
answer
Nitrous oxide Opioids Ketamine < 2 mg/kg
question
Which drugs are administered to increase uterine tone?
answer
Oxytocin PGF2a (Hemabate) Methylergonovine PGE1 (Misoprostol)
question
What is the incidence of postpartum hemorrhage? What is the most common cause?
answer
5%. Uterine atony.
question
What are two contraindications to Methylergonovine?
answer
HTN (preeclampsia) CAD
question
What is the dose of Methylergonovine?
answer
0.2 mg IM
question
What is the dose of Pitocin?
answer
20 - 60 U IV. Avoid rapid infusion
question
What is the dose of PGF2a?
answer
0.25 mg IM
question
What are two contraindications to PGF2a?
answer
Asthma Pulmonary HTN
question
Which medication is useful in the developing world for treatment of PPH?
answer
Misoprostol - it's thermostable and doesn't require IV access.
question
What is the trade name for misoprostol?
answer
Cytotec
question
What is the dose of misoprostol?
answer
800 - 1000 mcg PR (or buccal)
question
What is the effect of oxytocin bolus administration?
answer
Vasodilation
question
Which drugs or drug classes are used to DECREASE uterine tone?
answer
Beta-2 Agonists Magnesium Volatile anesthetics Methylxanthines
question
What are the beta-2 agonists used for tocolysis?
answer
Ritodrine Terbutaline
question
What are the effects of beta-2 agonism?
answer
Uterine relaxation Vasodilation Bronchodilation Gluconeogenesis Glycogenolysis Drives K+ into RBCs and muscle cells
question
What are two very concerning side effects of the beta agonists used for tocolysis?
answer
Pulmonary edema Arrhythmia
question
Which autonomic receptor subtype mediates uterine contraction?
answer
Alpha-1
question
What is the predominant autonomic influence on the ciliary muscle? What is the ciliary muscle?
answer
Parasympathetic. The ciliary muscle controls accommodation by stretching the lens of the eye for far vision. Relaxation (mediated by beta-2 agonism) promotes near vision by enabling the lens to become more spherical.
question
What is the beta-2 receptor affinity of norepinephrine?
answer
Virtually none.
question
What proportion of resting arterial pressure is determined by renin activity?
answer
85% (according to Miller)
question
Which tocolytic is associated with increased risk of gastric aspiration?
answer
10% Ethanol in D5W
question
What are the two major effects of magnesium at the NMJ?
answer
Decreased ACh release Decreased postsynaptic ACh sensitivity
question
Which class of tocolytics is associated with premature closure of the PDA, pulmonary HTN, and may predispose to bleeding problems?
answer
COX (prostaglandin synthetase) inhibitors
question
FETAL HEART RATE and FETAL WELL-BEING
answer
...
question
What is the definition of fetal bradycardia?
answer
FHR < 120 bpm
question
What is normal FHR variability?
answer
7 - 14 beats/min
question
What are early FHR decelerations?
answer
Decels that correlate with uterine contractions
question
What is thought to be the cause of early FHR decelerations?
answer
Compression of the fetal head, which leads to vagal stimulation of the fetus.
question
What are late FHR decelerations?
answer
FHR decelerations which begin after the onset of a uterine contraction AND persist after its conclusion.
question
What is thought to be the cause of late FHR decelerations?
answer
UTEROPLACENTAL INSUFFICIENCY. Immediate delivery is NOT mandatory, but fetal scalp pH probably should be checked.
question
What are variable FHR decelerations?
answer
Slowing of the FHR without direct relation to uterine contractions.
question
What is thought to be the cause of variable FHR decelerations?
answer
Umbilical cord compression
question
Which type of decelerations are most common?
answer
Variable decelerations
question
When are variable decelerations concerning? What can they indicate?
answer
Variable decelerations lasting longer than one minute suggest severe fetal acidosis with imminent in utero death.
question
What is normal scalp pH?
answer
7.25
question
What is the threshold for abnormal scalp pH?
answer
< 7.20
question
What is the most reliable method for assessment of fetal lung maturity?
answer
Lecithin:Sphingomyelin ratio
question
What are the components of amniocentesis?
answer
Analysis of: Chromosomes Bilirubin Phospholipids (L/S ratio)
question
When does lecithin start to exceed sphingomyelin?
answer
L > S after 35 weeks gestation
question
At what L:S ratio is neonatal RDS unlikely?
answer
L:S > 2
question
What is a useful measure of fetal muscle mass?
answer
Amniotic creatinine
question
What are two important methods by which to assess fetal maturity and placental function?
answer
Oxytocin stress test Fetal nonstress test
question
How is the oxytocin stress test performed? What are criteria for a positive test result?
answer
Oxytocin is given until contractions occur at a rate of 3 in 10 minutes. In a positive test, the fetus develops consistent late decels. A negative result is a very reliable indicator of fetal well-being.
question
How is a fetal nonstress test conducted?
answer
Uterine activity and FHR are monitored.
question
What are the possible results of the nonstress test?
answer
Reactive OR Nonreactive
question
What is a "reactive" nonstress test result?
answer
10 movements occur within 30 minutes, and each movement is associated with an increase in FHR.
question
NEWBORN RESUSCITATION IN BRIEF
answer
...
question
The Apgar score is a measure of...
answer
fetal asphyxia.
question
What are the gradations of fetal asphyxia by the Apgar score?
answer
Severe Mild Nonexistent
question
What Apgar score range requires immediate resuscitation?
answer
0 - 3
question
What is the "G" in Apgar? What are the three possible ratings in this category?
answer
GRIMACE - reflex irritability in response to a catheter in the nose. Normal response is cough, sneeze, or pull away. Impaired response is grimace only. Zero points for absent response.
question
What are the steps of neonatal resuscitation?
answer
1) Airway 2) Closed chest cardiac massage 3) Cannulate the umbilical artery 4) Drugs
question
What is the neonatal dose of narcan?
answer
0.01 mg/kg
question
What is the neonatal dose of epinephrine for resuscitation?
answer
5 mcg/kg
question
MYASTHENIC IN LABOR
answer
...
question
What is the safety of anticholinesterases in the parturient?
answer
Anticholinesterase therapy should be continued during labor.
question
Is epidural analgesia contraindicated in myasthenia?
answer
NO. Epidural is an excellent choice.
question
What is a major concern in the laboring patient with myasthenia gravis?
answer
Neonatal myasthenia.
question
How common is neonatal myasthenia?
answer
20 - 30% incidence in newborns whose mothers are afflicted.
question
What is the principal manifestation of neonatal myasthenia?
answer
Generalized weakness
question
How is neonatal myasthenia treated?
answer
Generally, anticholinesterase therapy is needed for the first three weeks of life.
question
What are the risks of neonatal myasthenia?
answer
Newborns of mothers with myasthenia gravis are at elevated risk for the development of RESPIRATORY INSUFFICIENCY.
question
Which coagulation factors decrease during pregnancy?
answer
Factors XI and XIII
question
What are the characteristics of Eisenmenger's Syndrome?
answer
Pulmonary hypertension with intracardiac right-to-left shunt
question
Two major side effects associated with the ergot alkaloids (methylergonovine) include...
answer
Hypertension and Bronchospasm
question
Which other uterotonic is associated with bronchospasm?
answer
Hemabate (PGF-2a)
question
What is the pediatric dose of naloxone?
answer
0.1 mg/kg
question
Which class of medications induce a dose-dependent reduction of uterine tone?
answer
BARBITURATES
question
What effect do IV local anesthetics have on uterine tone?
answer
INCREASED TONE
question
What is the most common cause of DIC in pregnant patients?
answer
Placental abruption
question
Why are patients with placenta previa and uterine scar from previous C-section at high risk of emergency hysterectomy for uncontrolled uterine bleeding?
answer
Because of the likelihood of placenta accreta
question
What is the risk of placenta accreta in a patient with placenta previa?
answer
5 - 7%
question
What is the risk of placenta accreta in a patient with placenta previa and a previous C-section?
answer
10 - 30%
question
What is the risk of placenta accreta in a patient with placenta previa and two previous C-sections?
answer
40 - 70%
question
What is the time to onset of epidural morphine?
answer
40 minutes
question
What happens to the elimination half-life of 2-chloroprocaine in the setting of homozygous atypical pseudocholinesterase?
answer
It will be prolonged from 21 minutes to about 2 hours
question
Which property of epidurally administered LAs determines the extent to which the drug's effect is prolonged by epinephrine?
answer
Lipid solubility
question
What is the most common side effect of intrathecal opioids?
answer
Pruritus
question
What are the four cardinal features of AFE?
answer
Dyspnea, hypoxemia, cardiovascular collapse, and coma
question
What is the most important means for placental transfer of drugs?
answer
Diffusion
question
Which three antihypertensives can be associated with postpartum hemorrhage?
answer
Nitroprusside, nitroglycerin, and nifedipine
question
What are six side effects associated with Hemabate (carboprost)?
answer
Bronchospasm V/Q mismatch Hypoxemia Fever Diarrhea N/V
question
What is the dose of PGF-2a?
answer
250 mcg IM
question
What are three treatments that can reduce shivering in parturients?
answer
Sufentanil, meperidine, and warmed IV fluids
question
What are the opioid receptor affinities of meperidine?
answer
Mu and Kappa agonism
question
What is the appropriate neonatal resuscitation dose of epi?
answer
0.1 - 0.3 mL/kg of 1:10,000 (10 - 30 mcg/kg)
question
What is the appropriate neonatal resuscitation dose of normal saline?
answer
10 mL/kg
question
What is the appropriate neonatal resuscitation dose of sodium bicarbonate?
answer
2 mEq/kg
question
What is the appropriate neonatal resuscitation dose of naloxone?
answer
0.1 mg/kg
question
How much epinephrine is in a 1:200,000 solution?
answer
5 mcg/mL
question
How much epinephrine is in a 1:10,000 solution?
answer
100 mcg/mL
question
The effects of which epidural drugs are reduced by prior epidural administration of 2-chloroprocaine?
answer
Fentanyl, Morphine, Bupivacaine
