Obstetric Anesthesia and Analgesia Flashcards

What is the recommended left lateral tilt angle for a term pregnant patient undergoing general anesthesia to prevent aortocaval compression?

Answer: 15-30 degrees

Left lateral tilt of 15-30 degrees (typically using a wedge under the right hip) effectively displaces the gravid uterus off the aorta and inferior vena cava.

A parturient receives magnesium sulfate for eclampsia prophylaxis. Which finding would prompt immediate magnesium discontinuation?

Answer: Respiratory rate of 10/min

Respiratory rate below 12/min indicates respiratory depression from hypermagnesemia and requires immediate cessation and calcium gluconate administration.

Which statement about remifentanil patient-controlled analgesia (PCA) for labor is CORRECT?

Answer: It carries risk of maternal apnea requiring monitoring

Remifentanil PCA can cause maternal apnea and oxygen desaturation, requiring continuous SpO2 monitoring and 1:1 nursing care.

In a patient with placenta previa requiring cesarean delivery, which anesthetic consideration is MOST important?

Answer: Prepare for massive hemorrhage and have blood products ready

Placenta previa carries high risk of massive hemorrhage; large-bore IV access, crossmatched blood, and cell salvage should be prepared before incision.

What is the most common cause of maternal death directly attributable to anesthesia in obstetrics?

Answer: Failed intubation with hypoxia

Failed or difficult intubation leading to hypoxia remains the leading anesthesia-related cause of maternal mortality, driving the preference for regional techniques.

A postpartum patient develops a severe positional headache 24 hours after epidural placement. What is the definitive treatment?

Answer: Epidural blood patch

Epidural blood patch (injecting 15-20 ml autologous blood into the epidural space) has an ~85% success rate and is the definitive treatment for PDPH.

Which uteroplacental characteristic is MOST relevant when selecting opioids for cesarean section spinal anesthesia?

Answer: pH partitioning causes opioid trapping in fetal circulation

Ion trapping occurs when fetal acidosis converts lipid-soluble opioids to ionized forms that cannot cross back, accumulating in fetal circulation.