Apex Anesthesia, Across the Lifespan Questions With Solutions
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Apex Anesthesia, Across the Lifespan Questions With Solutions
How does pregnancy affect minute ventilation? - Correct answerProgesterone is a respiratory stimulant, it increases minute ventilation by up to 50%
-Vt increases by 40%
-RR increases by 10%
How does pregnancy affect the mot...
Apex Anesthesia, Across the Lifespan
Questions With Solutions
How does pregnancy affect minute ventilation? - Correct answerProgesterone is a respiratory stimulant, it
increases minute ventilation by up to 50%
-Vt increases by 40%
-RR increases by 10%
How does pregnancy affect the mother's abg? - Correct answerProgesterone is a respiratory stimulant. It
increases minute ventilation up to 50%. In consequence, mom's PaCO2 falls and she develops respiratory
alkalosis. Renal compensation eliminates bicarbonate to normalize blood pH. A small reduction in physiologic
shunt explains the mild increase in PaO2. This increases the driving pressure of oxygen across the feoplacental
interface and improves fetal gas exchange.
How does pregnancy affect the oxyhemoglobin dissociation curve? - Correct answerRight shift = increased P50
= facilitates O2 unloading in the fetus
How does pregnancy affect the lung volumes and capacities - Correct answerFRC is reduced as a function of
decreased ERV and RV. ERV decreases more than RV.
An increased oxygen consumption paired with a decreased FRC hastens the onset of hypoxemia. Failure to
reverse hypoxemia results in brain death of the mother and the fetus.
How does cardiac output change during pregnancy and delivery? - Correct answer
How do blood pressure and systemic vascular resistance change during pregnancy? - Correct answer
Who is at risk for aortocaval compression, and how do you treat it? - Correct answerIn the supine position, the
gravid uterus compresses both the vena cava and the aorta. This decreases venous return to the heart as well
as the arterial flow to the uterus and LE. Decreased CO compromises fetal perfusion and can also cause the
mother to lose consciousness.
By displacing the uterus away from the vena cava and aorta, we can reduce its compressive effect. We can
accomplish this by elevating the mother's right torso 15 degrees. It should be used for anyone in their second or
third trimester.
How does the intravascular fluid volume change during pregnancy? - Correct answer
What hematologic changes accompany pregnancy? - Correct answer
How does MAC change during pregnancy - Correct answerMAC is decreased by 30-40% due to increased
progesterone
How does pregnancy affect gastric pH and volume? - Correct answerIncreases gastric volume and decreases
gastric pH. Due to increased gastrin.
,How does pregnancy affect gastric emptying? - Correct answer-Before onset of labor = no change
-After onset of labor = slowed
How does pregnancy affect uterine blood flow? - Correct answerAt term, uterine blood flow increases to 500-
700 mL/min (10% of CO)
What conditions can reduce uterine blood flow? - Correct answer-Uterine blood flow does not autoregulate →
dependent on MAP, CO, and uterine vascular resistance
Discuss the use of phenylephrine and ephedrine in the laboring patient - Correct answerClassic teaching states
that phenylephrine increases uterine vascular resistance and reduces placental perfusion.
More recent evidence suggests that phenylephrine is as efficacious as ephedrine in maintaining placental
perfusion and fetal pH in healthy mothers. Mothers that received phenylephrine had higher fetal pH values (less
fetal acidosis)
Which law determines which drugs will pass through the placenta? - Correct answerThe Fick principal
determines which drugs can pass across the placenta
Drug characteristics that favor placental transfer:
-Low molecular weight < 500 daltons
-High lipid solubility
-Unionized
-Nonpolar
Define the 3 stages of labor - Correct answer-Stage 1: Beginning of regular contractions to full cervical dilation
(10 cm)
-Stage 2: Full cervical dilation to delivery of the fetus
-Stage 3: Delivery of the placenta
How does uncontrolled labor pain affect the fetus? Why? - Correct answerUncontrolled pain may result in
Maternal hyperventilation = leftward shift of oxyHgb curve = reduced delivery of O2 to the fetus.
Compare and contrast the pain that results from the first and second stages of labor. - Correct answerFirst
stage- Pain begins in the lower uterine segment and the cervix.
Origin: T10-L1 posterior nerve roots
Second stage- adds in pain impulses from the vagina, perineum, and pelvic floor.
Origin: S2-S4 posterior nerve roots
Compare and contrast the regional anesthetic techniques that can be used for first and second stage labor pain
- Correct answerNeuraxial techniques that provide analgesia to T10-L1 during the first stage of labor must be
extended to cover S2-S4 during the second stage of labor.
Describe the "needle through needle" technique for CSE. - Correct answerThe CSE technique provides the dual
, benefit of a rapid onset of spinal anesthesia and the ability to prolong the duration of anesthesia with an
indwelling epidural catheter. This technique is particularly useful in labor and delivery.
The needle through the needle technique is the most common approach.
The epidural space is identified with the epidural needle.
A spinal needle is placed through the epidural needle, and then LA and/or opioid is injected into the intrathecal
space
The spinal needle is removed
An epidural catheter is threaded through the epidural needle.
Compare and contrast bupivacaine and ropivacaine for labor - Correct answer
Discuss the use of 2-chloroprocaine for labor - Correct answer-Useful for emergency C/S when epidural is
already in place
-Metabolized by pseudocholinesterase in the plasma - minimal placental transfer
-Antagonizes opioid receptors (mu & kappa) and reduces the efficacy of epidural morphine
-Risk of arachnoiditis when used for spinal
Discuss the consequence of an epidural that is placed in the subdural space - Correct
answerRare/unpreventable, tip of the epidural catheter is in the subdural space between dura and arachnoid.
Neither catheter aspiration or a test dose will r/o subdural placement.
Within 10-25 minutes after the epidural is dosed, the patient will experience symptoms of an excessive cephalad
spread of LA. Because the subdural space is a potential space, it holds a very low volume. For this reason, the
block height for a given amount of local anesthetic will be much higher than if the same volume was
administered in the epidural space.
What is the treatment for a total spinal? - Correct answerA total spinal may result from:
-An epidural dose injected into the subarachnoid space
-An epidural dose injected into the subdural space
-A single shot spinal after a failed epidural block
Treatment: Vasopressors, IVF, left uterine displacement, elevation of legs, intubation if LOC
Discuss the fetal heart rate - Correct answerThe FHR is a surrogate measure of overall fetal wellbeing. It
provides an indirect method to assess fetal hypoxia and acidosis. Use of this modality guides clinical decision
making, so that we can minimize the risk of fetal injury and demise.
Fetal oxygenation is a function of uterine and placental blood flow. The fetus responds to stress with peripheral
vasoconstriction, HTN, and a baroreceptor mediated reduction in heart rate.
Which type of fetal decelerations are unremarkable? - Correct answerEarly decelerations do not present a risk
of fetal hypoxemia.
Which type of fetal decelerations cause concern? - Correct answer-Late and variable decelerations require
urgent assessment of fetal status
What are the common causes of fetal deceleration - Correct answerVEAL CHOP
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