Principles II- Exam 3

The statement is true because emergent c-sections are usually performed in urgent situations where there is a higher risk to the mother and baby. These situations may include complications during labor or delivery that require immediate intervention. The urgency of the procedure can increase the likelihood of complications such as maternal aspiration, which is the inhalation of stomach contents into the lungs. Therefore, the incidence of maternal aspiration is indeed higher for emergent c-sections.

Placenta previa is a condition where the placenta partially or completely covers the cervical opening, which can lead to bleeding during pregnancy. This condition occurs when the placenta implants low in the uterus, near or over the cervix. It can cause complications such as bleeding, premature birth, and fetal distress. Placenta previa is typically diagnosed through ultrasound and managed based on the severity of symptoms and gestational age. Treatment options may include bed rest, medication, or in severe cases, delivery by cesarean section.

This statement is true because it is a standard practice in obstetrics to consider all patients going for a c-section to have full stomachs, regardless of the duration of their fasting (NPO) period. This is because there is a risk of aspiration during surgery, where stomach contents can enter the lungs and cause complications. Therefore, precautions are taken to minimize this risk, such as using medications to reduce stomach acid and using rapid sequence induction techniques during anesthesia.

Amniotic fluid embolism is not a cause of antepartum hemorrhage. Antepartum hemorrhage refers to bleeding that occurs before the birth of a baby. The most common causes of antepartum hemorrhage are placenta previa, uterine rupture, and abruptio placentae. Amniotic fluid embolism, on the other hand, is a rare and life-threatening condition where amniotic fluid enters the maternal bloodstream, causing an allergic reaction and potentially leading to severe complications. However, it does not directly cause bleeding during pregnancy.

Awake extubation is the recommended approach for pregnant patients upon emergence from general anesthesia. This is because it allows for a smoother transition and reduces the risk of complications. Keeping the patient awake during the extubation process ensures that their airway is protected and allows for immediate intervention if any respiratory distress or airway obstruction occurs. Additionally, awake extubation allows for the assessment of the patient's respiratory function and ability to maintain a patent airway independently.

Pregnancy can decrease the MAC (minimum alveolar concentration) of anesthetics. This is because during pregnancy, there are physiological changes in the body that can affect the metabolism and distribution of anesthetics. Increased hormone levels, changes in cardiac output, and alterations in respiratory function can all contribute to a decreased MAC. Additionally, the increased sensitivity to anesthetics during pregnancy may also be due to changes in the central nervous system.

As an anesthetist, your primary concern is the safety and well-being of the patient. In this case, the patient is the mother. If intubation fails, it is crucial to prioritize saving the mother's life as she is the one undergoing the procedure and is at immediate risk. While the fetus is also important, the mother's life takes precedence in this situation.

Regional anesthesia is the preferred anesthetic method for obstetric patients because it provides effective pain relief while minimizing the risks associated with general anesthesia. Regional anesthesia techniques, such as epidurals or spinal blocks, can be used to numb specific areas of the body, allowing the patient to remain awake and alert during childbirth. This method also allows for better control of pain during labor and delivery, and reduces the risk of complications for both the mother and the baby.

A patient with aortic stenosis is not a good candidate for spinal anesthesia because the procedure can cause a sudden decrease in blood pressure, which can be dangerous for patients with aortic stenosis. Spinal anesthesia can lead to vasodilation and decrease in systemic vascular resistance, which can worsen the already compromised cardiac function in patients with aortic stenosis. Therefore, it is not recommended to use spinal anesthesia in these patients to avoid potential complications.

During vaginal delivery, the pain is somatic in origin and mainly derived from nerve fibers originating from the sacral spinal cord segments S1-S4. These nerve fibers innervate the perineum and pelvic floor muscles, which are involved in the birthing process. The somatic pain experienced during vaginal delivery is typically sharp and localized, as opposed to visceral pain, which is more diffuse and dull.

In an obese patient in labor, it is important to make every effort to initiate early regional anesthetic. This is because regional anesthesia, such as epidural or spinal anesthesia, can provide effective pain control during labor. Obesity can make it challenging to locate anatomical landmarks for regional blocks, but initiating the anesthesia early can help overcome this difficulty. Additionally, regional anesthesia allows for better pain management compared to anxiolytic and opioids alone. Therefore, the focus should be on providing early regional anesthesia to ensure optimal pain control for the obese patient in labor.

During pregnancy, there are several respiratory changes that occur. One of these changes is an increase in tidal volume and minute ventilation, which leads to a decrease in functional residual capacity (FRC). This decrease in FRC can result in the need for larger endotracheal tubes (ETTs) to accommodate the increased airway resistance. Additionally, the O2 dissociation curve shifts to the right during pregnancy, allowing for increased oxygen delivery to the fetus. Respiratory alkalosis may also be normal due to the increased respiratory drive. Therefore, the statement "Pts will need larger ETT's" is not true of respiratory changes during pregnancy.

Placental exchange occurs primarily via diffusion. Diffusion is the passive movement of molecules from an area of higher concentration to an area of lower concentration. In the placenta, oxygen and nutrients from the mother's blood diffuse across the placental membrane into the fetal blood, while waste products such as carbon dioxide diffuse from the fetal blood into the mother's blood. This process allows for the exchange of gases, nutrients, and waste products between the mother and the developing fetus. Active transport, osmosis, and forced filtration are not the primary mechanisms for placental exchange.

Given the patient's past history of aortic stenosis, a general anesthetic technique would be preferred for a c-section. General anesthesia provides a controlled and deep level of sedation, allowing for optimal airway management and cardiovascular stability during the procedure. This is especially important in a patient with aortic stenosis, as regional anesthesia techniques may cause sudden drops in blood pressure or compromise cardiac function. Therefore, a general anesthetic technique is the safest option for this patient.

HELLP syndrome is a serious condition that can occur during pregnancy and is characterized by Hemolysis (breakdown of red blood cells), Elevated liver Enzymes, and Low Platelet count. It is not typically associated with Hypotension (low blood pressure). Hypotension is more commonly seen in conditions like preeclampsia or eclampsia. Therefore, the correct answer is Hypotension.

The optimal surgical position for a patient undergoing a c-section to prevent hypotension is supine and slightly lateral. This position helps to improve blood flow to the heart and brain, reducing the risk of hypotension. The supine position allows for proper ventilation and oxygenation, while the slight lateral tilt prevents compression of the inferior vena cava, ensuring adequate venous return. This position also provides good access to the surgical site and allows for effective monitoring of the patient's vital signs during the procedure.

Increased intragastric pressure, lower esophageal sphincter tone, and delayed gastric emptying all contribute to an increased risk of aspiration during anesthesia for pregnant patients. Aspiration occurs when stomach contents enter the lungs, which can lead to serious complications such as pneumonia. Increased intragastric pressure can occur due to the growing uterus pressing on the stomach, causing the contents to be pushed upwards. Lower esophageal sphincter tone can allow stomach acid and contents to reflux into the esophagus and potentially into the lungs. Delayed gastric emptying can result in a larger volume of stomach contents, increasing the risk of aspiration. Therefore, all of these factors contribute to an increased risk of aspiration during anesthesia for pregnant patients.

The optimal positioning for 2nd - 3rd trimester pregnant patients is not supine. This position can compress the inferior vena cava, reducing blood flow to the heart and uterus, potentially causing hypotension and decreased fetal oxygenation. Instead, the optimal position is left lateral tilt or a modified supine position with a wedge under the right hip, which helps to alleviate pressure on the vena cava.

During pregnancy, there is an increase in plasma cholinesterase activity. This is because pregnancy hormones can stimulate the production of cholinesterase, an enzyme responsible for breaking down certain medications, including anesthetics. As a result, the increased activity of plasma cholinesterase can lead to a more rapid metabolism and elimination of anesthetics from the body, potentially requiring higher doses or more frequent administration of anesthesia during pregnancy.

Mrs. A, who has severe mitral stenosis, is an absolute contraindication to spinal anesthesia. Mitral stenosis is a condition where the mitral valve in the heart is narrowed, leading to impaired blood flow. Spinal anesthesia can cause a decrease in blood pressure, which can be dangerous for patients with mitral stenosis as it can further compromise blood flow to the heart. Therefore, it is not safe to administer spinal anesthesia to Mrs. A.

During the first and second trimesters of pregnancy, the pregnant individuals are actually considered to be at an increased risk of aspiration. This is because the growing uterus can push the stomach upwards, leading to a decrease in the space available for the stomach to expand. As a result, the stomach contents may be more likely to reflux into the esophagus and potentially be aspirated into the lungs. Therefore, pregnant individuals should be cautious and take measures to minimize the risk of aspiration during these trimesters.

Maintaining the patient in an upright position and on bedrest is not an appropriate treatment for Post dural Puncture headache. This position may actually worsen the headache as it increases the pressure in the head. The other options, such as a Blood Patch (a procedure to seal the hole in the dura), Oral/IV hydration (to increase fluid volume), and IV Caffeine (to constrict blood vessels and reduce headache) are appropriate treatments for Post dural Puncture headache.

The administration of magnesium drip to stop contractions can lead to a prolonged duration of action of muscle relaxants. Magnesium is known to potentiate the effects of muscle relaxants, resulting in a slower metabolism and elimination of these drugs from the body. Therefore, the anesthetic technique should take into account the potential for a prolonged effect of muscle relaxants, requiring careful monitoring and adjustment of medication dosages to ensure appropriate muscle relaxation during the procedure.

Succinylcholine is the muscle relaxant of choice for induction of a pregnant patient because it has a rapid onset of action and a short duration of effect. This allows for quick and effective muscle relaxation during intubation without causing prolonged paralysis, which could be harmful to the mother and fetus. Additionally, succinylcholine does not cross the placenta easily, minimizing the potential for adverse effects on the fetus.

Bicitra is commonly given to pregnant patients undergoing general anesthesia as a nonparticulate antacid. It helps to neutralize stomach acid and prevent acid reflux during surgery. This is important because acid reflux can cause complications during anesthesia. Bicitra is a liquid medication that contains citric acid and sodium citrate, which work together to reduce stomach acidity. It is considered safe for use in pregnant patients and is often preferred over other antacids due to its nonparticulate nature, which means it does not form particles that could potentially cause harm.

Versed, also known as midazolam, is considered unsafe to give during pregnancy. It belongs to a class of medications called benzodiazepines, which can potentially harm the developing fetus. Benzodiazepines have been associated with an increased risk of birth defects and other adverse effects when used during pregnancy. Therefore, it is generally recommended to avoid the use of Versed or any other benzodiazepine during pregnancy, unless the potential benefits outweigh the potential risks.

Fetal deceleration that occurs 30 seconds after the onset of uterine contractions indicates fetal distress. This delay suggests that the fetus is not receiving enough oxygen during contractions, which can be a sign of fetal distress. The timing of the deceleration in relation to the contractions is crucial in determining fetal well-being.

During the first trimester of pregnancy, the fetus is most sensitive to drugs. This is because during this period, the major organs and systems of the fetus are developing rapidly. Any exposure to drugs or medications during this time can potentially interfere with the normal development of the baby and increase the risk of birth defects or other complications. Therefore, it is important for pregnant women to be cautious about taking any medications or drugs during the first trimester to ensure the health and well-being of the fetus.

Precipitous labor is not an indication for general anesthesia because it refers to a labor that progresses very quickly, with the baby being delivered within a few hours of contractions starting. In such cases, there is usually no need for general anesthesia as the labor is fast and the baby can be delivered without the need for additional pain management or interventions. General anesthesia is typically used in situations such as fetal distress, excessive bleeding (hemorrhaging), or when a regional block (such as an epidural) fails to provide adequate pain relief.

The epidural catheter should be inserted 3-5 cm. This is the recommended depth for insertion to ensure that the catheter is properly placed and can effectively deliver anesthesia. Inserting the catheter too shallow or too deep can result in inadequate pain relief or complications.

The correct answer is 10-20 cc's. This is the recommended volume for injecting a blood patch to treat post-dural puncture headache (PDPH). The blood patch involves injecting the patient's own blood into the epidural space to form a clot and seal the puncture site, relieving the headache. The specific volume within the range of 10-20 cc's may vary depending on the size of the patient and the severity of the headache.

Uterine blood flow is not autoregulated. Autoregulation refers to the ability of an organ to maintain a constant blood flow despite changes in blood pressure. In the case of the uterus, its blood flow is not autoregulated and can vary depending on factors such as hormonal changes, pregnancy, and menstrual cycle.

Aspiration is the leading cause of maternal death under general anesthesia. This occurs when stomach contents are inhaled into the lungs, leading to a blockage of the airways and potentially causing severe respiratory distress or even death. During general anesthesia, the patient's protective airway reflexes are suppressed, increasing the risk of aspiration. Proper precautions, such as fasting before surgery and the use of medications to reduce stomach acid, can help minimize this risk.

A pregnant patient with pre-eclampsia would most likely be placed on Magnesium Sulfate drip. Magnesium Sulfate is the preferred treatment for pre-eclampsia as it helps in preventing seizures and controlling blood pressure. It acts as a smooth muscle relaxant and vasodilator, reducing the risk of eclamptic seizures. Labetolol is also used to control blood pressure in pre-eclampsia, but Magnesium Sulfate is the first-line treatment for preventing seizures in these patients. Hydralazine and Sodium Nitroprusside are not commonly used in the management of pre-eclampsia.

During a cesarean section with epidural in place, the goal is to achieve a sensory blockade at the T4 level. This is because the T4 dermatome corresponds to the level of the umbilicus, which is the area where the surgical incision is typically made during a cesarean section. By achieving a sensory blockade at the T4 level, the patient will not feel any pain or discomfort during the procedure.

The given options in the question are different statements about a person. The first statement expresses fear or shock, the second one uses a slang term to describe the person's appearance, and the third statement acknowledges that despite being a man, the person is attractive. The correct answer "All the above" indicates that all of these statements are true or applicable to the person in question.

During the first stage of labor, the pain felt is visceral in origin and derived from nerve fibers originating from the T10-L1 region. This region corresponds to the thoracic and lumbar spinal segments, which innervate the lower abdomen and pelvis. The pain is experienced in these areas due to the contraction and stretching of the uterus and cervix during labor.

A failed regional block refers to the inability to achieve adequate pain relief during labor using regional anesthesia techniques such as epidural or spinal anesthesia. This is not an indication for cesarean section as it does not directly impact the safety or well-being of the mother or baby. Cesarean section is typically performed in cases of fetal distress (when the baby is not receiving enough oxygen), dystocia (difficult or prolonged labor), and cephalopelvic disproportion (when the baby's head is too large to pass through the mother's pelvis).

Respiratory events are the most common precipitating events leading to adverse outcomes in obstetric anesthesia. This could include complications such as airway obstruction, aspiration, or inadequate ventilation. These events can have serious consequences for both the mother and the fetus, potentially leading to hypoxia, respiratory distress, or even cardiac arrest. It is essential for obstetric anesthesiologists to be vigilant and prepared to manage and prevent these respiratory events to ensure the safety and well-being of both the mother and the baby.

Mrs. Berri's sudden scream and complaint of severe pain, along with the observation of the baby's heart rate going down on the FHR monitor, indicates a possible uterine rupture. This is a serious complication where the uterus tears during labor, which can lead to significant bleeding, fetal distress, and potential harm to both the mother and the baby. Given Mrs. Berri's history of a prior vaginal delivery and a prior c-section, the risk of uterine rupture is increased. Immediate medical attention and intervention are required in such cases to ensure the safety of both the mother and the baby.

In the case of an obstetric patient who has just aspirated, all of the interventions mentioned would be appropriate. Administration of steroids may help reduce inflammation and prevent complications. Administration of antibiotics can help prevent or treat any infection that may have resulted from the aspiration. Suction is necessary to remove any aspirated material from the airway and improve breathing. Therefore, all of these interventions are necessary and appropriate in managing the patient's condition.

Largest increase in CO is immediately following delivery.

In this scenario, the correct answer is to maintain ventilation with cricoid pressure and proceed with surgery. This is because the patient is in need of an emergent c-section due to fetal distress and there is no time to insert an epidural for regional anesthesia. Although the rapid sequence induction was unsuccessful in intubating the patient, the priority is to ensure that the patient is adequately ventilated and oxygenated. By maintaining ventilation with cricoid pressure, the patient's airway can be protected while the surgery proceeds. Other options such as retrograde intubation or awake fiberoptic intubation may not be feasible or may cause further delay in the surgery.

Compazine (prochlorperazine) is an antiemetic medication that belongs to the phenothiazine class. It works by blocking dopamine receptors in the brain, which helps to reduce nausea and vomiting. However, Compazine has been associated with a higher risk of causing extrapyramidal symptoms, including dystonia, akathisia, and tardive dyskinesia. These symptoms can be particularly dangerous for pregnant patients as they can increase the risk of aspiration. Therefore, Compazine should not be given to prevent aspiration in a pregnant patient.

During pregnancy, there is an increase in plasma concentration of coagulation factors. This is because the body prepares for potential blood loss during childbirth. The increased concentration of coagulation factors helps in the formation of blood clots to prevent excessive bleeding.

Aspiration is the inhalation of stomach contents into the lungs, which can lead to serious complications. It is more likely to occur in certain situations, such as emergent c-sections, eclamptic patients, and difficult intubations, where there may be a higher risk of regurgitation or vomiting. Being overdue by 2 weeks does not directly increase the risk of aspiration, so it is less likely to occur in this situation.

Spinal and Epidural anesthesia are not known to decrease uterine blood flow. In fact, these types of anesthesia are commonly used during childbirth to provide pain relief while minimizing the impact on uterine blood flow. They work by blocking nerve signals in the spine, allowing the mother to be comfortable during labor while still maintaining adequate blood flow to the uterus. Therefore, the statement that spinal and epidural anesthesia decrease uterine blood flow is incorrect.

Organogenesis is the process of organ formation during embryonic development. It occurs during the first two months of pregnancy, specifically in the embryonic stage. During this time, the basic structures of major organs and systems are formed. After the first two months, the organs continue to grow and develop, but the major groundwork of organogenesis is completed.

Nitrous oxide (N2O) must be avoided during pregnancy because it interferes with folic acid metabolism, which is essential for DNA synthesis. Folic acid is crucial for the development of the fetal neural tube and plays a vital role in preventing birth defects. Impairing DNA synthesis can lead to various complications and abnormalities in the developing fetus. Therefore, it is important to avoid nitrous oxide during pregnancy to ensure proper folic acid metabolism and DNA synthesis.

Placing the patient in a lateral position during the administration of an epidural will not help decrease the incidence of Post-Dural Puncture Headache (PDPH). PDPH is a common complication of epidural procedures, characterized by a severe headache that worsens when sitting or standing. The use of rounded point needles, smaller gauge needles, and ensuring the needle is oriented parallel to the meningeal fibers can help decrease the incidence of PDPH. However, the position of the patient during administration does not have a significant impact on the occurrence of PDPH.