What does hypotension and the parturient most closely related to?

A reduction in SVR (versus changes in preload, heart rate and contractility)

What is the critical pressure (systolic in a normal parturient0?

100 mmHg

What type of drug is Ephedrine?

synthetic, nonselective sympathomimetic drug

What doses of Ephedrine are used to treat hypotension? What is the duration of a 5-10 mg dose?

5-25 mg to tx hypotension

Duration of a 5-10 mg dose is about 5 minutes

Ephedrine causes _________ beta stimulation and _______ alpha stimulation through the relase of endogenous norephinephrine.

Direct beta stimulation

Indirect alpha stimulation

What is the favorite vasopressor in OB and why?

Ephedrine because it has little effect on uterine blood flow.

Does Ephedrine cross the placental barrier?

YES

What is the biggest problem w/ Ephedrine use?

Tachycardia which reduces filling times, thus a reduction in reload can occur.

For yrs Phenylephrine was thought to produce fetal acidosis due to a reduction in uterine blood flow. Why?

Because its a pure alpha agonist. however now, fetal studies indicate NO change in fetal pH or Apgar scores

If my patient is excessively tachycardia, which drug for hypotension should I use?

Phenylephrine-a good alternative if tachyphylaxis or excessive tachycardia occurs with ephedrine

Another option in severe  hypotension is epi

What are the overwhelming majority of fatalities due to during c-sections?

Cardiac arrest/ hypxia

what is the #1 reason for fatalities during c-sections?

Can't intubate/ Can't ventilate

What is/are the drugs used for a typical epidural bolus?

3% 2-chloroprocaine (rapid onset, short duration) or 2% lidocaine (intermediate onset, intermediate duration) w/ or w/out epi

*Both should be preservative free and intended for intrathecal injection

The addition of epinephrine should be carefully weighed w/ women who have what?

PIH or essential hypertension

This is the desired level for a c-section?

T-3 or T-4

Can you use Bupivicaine for an epidural?

yes, but negative aspiration of the epidural catheter does NOT insure that the catheter is not in a vein. And we all know the effects of IV bupivicaine....

What is the total volume of solution given for an epidural?

15-25 ml of solution given in divided doses until the desired level is reached

What will help with the pain assoicated w/ uterus manipulation (post infant delivery)?

The addition of a narcotic in the epidural solution (fentanyl or morphine/duramorph)

What is the most common dose for SAB? And what should be done before?

Hyperbaric 0.75% bupivicaine (1.4-1.8 ml)

Fluid bolus of 20 m./kg to reduce hypotension

Your giving a SAB and the patient is unable to speak, has a weak effort or desats. What do you do?

Place them under general anesthesia & intubate

what is the problem w/ using intrathecal morphine to improve pain?

It is assoicated w/ a higher incidence of respiratory depression and itching (although lasts longer)

Since all c-sections are "full stomachs" what should be given?

H2 blocker, metoclopramide and a nonparticulate antacid (bicitra 30 cc)

What does Bicitra do?

raises the pH of the gastric acid for up to an hour and should be given prior to induction

List 3 factors that contribute to blood loss during a C-section?

1- surgical time

2- surgical technique

3- patient blood pressure (PIH)

4-Fetal lie (breech, prematurity, multiparity)

5-maternal coagulation status

6-ability of uterus to contract after infant removal

List four reasons regional is preferred over general?

1- mom get to enjoy birthing process & first site of infant

2-parents get to bond w/ child

3-regional provides post op pain relief (temporarily)

4-drug introduction into maternal system may enter fetal circulation

When is a general chosen over a cesarean?

1- outwardly refusal of regional technique

2- anesthesia provider is not comfortable w/ administration of regional

3-section is emergent-no time for regional

4- placement is contraindicated (footling breech or cord prolapse)

How many intubations in obstetric patients fail? & Why?

1:250 fail

Airway is challenging because of airway edema, large breasts, cephalad displacement of thorax, full stomach

What size ETT should be used?

6.0 - 6.5