Obstetric Anesthesia and Analgesia Flashcards

During emergent cesarean section under general anesthesia, which sequence correctly follows rapid sequence induction?

Answer: Preoxygenate, cricoid pressure, induction agent, succinylcholine, intubate without ventilation

Obstetric RSI includes preoxygenation, cricoid pressure application before induction, thiopental or propofol then succinylcholine, and intubation without positive pressure ventilation.

Uterotonic oxytocin given as an IV bolus during cesarean section can cause which serious hemodynamic effect?

Answer: Severe hypotension and tachycardia

Rapid IV oxytocin bolus causes vasodilation and severe hypotension with reflex tachycardia; slow infusion is preferred to minimize cardiovascular effects.

Which finding on fetal heart rate monitoring during epidural analgesia initiation MOST warrants emergent delivery?

Answer: Prolonged bradycardia below 80 bpm lasting >3 minutes

Sustained fetal bradycardia below 80 bpm for more than 3 minutes is a Category III tracing indicating fetal compromise requiring emergent delivery.

What is the recommended approach when a 'walking epidural' technique is desired for labor analgesia?

Answer: Low-dose bupivacaine 0.0625% with intrathecal fentanyl via CSE

CSE with low-dose local anesthetic and lipid-soluble opioid provides analgesia with preserved motor function, allowing ambulation when monitored safely.

A parturient with antiphospholipid syndrome on therapeutic low-molecular-weight heparin presents for delivery. When is neuraxial anesthesia safe to perform?

Answer: 12 hours after prophylactic or 24 hours after therapeutic LMWH dose

ASRA guidelines recommend waiting 12 hours after prophylactic LMWH and 24 hours after therapeutic LMWH before neuraxial procedures to minimize epidural hematoma risk.

Which statement about intrathecal morphine for postcesarean analgesia is CORRECT?

Answer: Standard dose is 0.1-0.2 mg with peak effect at 6-8 hours

Intrathecal morphine 0.1-0.2 mg provides excellent postcesarean analgesia with peak effect at 6-8 hours and risk of delayed respiratory depression up to 24 hours.

Which maternal condition is an absolute contraindication to neuraxial anesthesia for labor and delivery?

Answer: Patient refusal

Patient refusal is an absolute contraindication to any anesthetic procedure; all other listed conditions represent relative contraindications requiring individualized risk assessment.