EDAIC Obstetric Anesthesia and Analgesia 2 — Questions and Answers
Question 1: A parturient with severe preeclampsia requires cesarean delivery. Which antihypertensive is CONTRAINDICATED in this setting?
- Labetalol
- Hydralazine
- ACE inhibitors (Correct answer)
- Nicardipine
Correct answer: ACE inhibitors
ACE inhibitors are contraindicated in pregnancy due to fetal renal toxicity and oligohydramnios.
Question 2: During spinal anesthesia for cesarean section, the patient develops hypotension. What is the FIRST-LINE vasopressor according to current evidence?
- Ephedrine
- Phenylephrine (Correct answer)
- Norepinephrine
- Dopamine
Correct answer: Phenylephrine
Phenylephrine is first-line for spinal-induced hypotension in cesarean delivery as it better preserves uteroplacental blood flow and fetal acid-base status.
Question 3: Which feature of the pregnant airway increases the risk of difficult intubation compared to non-pregnant patients?
- Decreased Mallampati score
- Mucosal edema and friability (Correct answer)
- Reduced tongue size
- Increased mouth opening
Correct answer: Mucosal edema and friability
Pregnancy causes airway mucosal edema, engorgement, and friability that worsen Mallampati class and increase bleeding risk during instrumentation.
Question 4: What is the approximate minimum alveolar concentration (MAC) change for volatile anesthetics during pregnancy?
- Increased by 20-30%
- No significant change
- Decreased by 25-40% (Correct answer)
- Decreased by 5-10%
Correct answer: Decreased by 25-40%
MAC is reduced by approximately 25-40% during pregnancy due to elevated progesterone and endorphin levels.
Question 5: A patient at 36 weeks gestation presents with acute pulmonary edema. Which condition is MOST likely if she has no prior cardiac history?
- Myocardial infarction
- Peripartum cardiomyopathy
- Tocolytic-induced pulmonary edema (Correct answer)
- Pulmonary embolism
Correct answer: Tocolytic-induced pulmonary edema
Beta-agonist tocolytics (e.g., terbutaline) cause sodium and water retention plus increased cardiac output, leading to pulmonary edema at late preterm gestation.
Question 6: For labor epidural analgesia, which combination provides the most effective pain relief with least motor block?
- High-dose bupivacaine alone
- Low-dose bupivacaine + fentanyl (Correct answer)
- Morphine alone
- High-dose lidocaine + epinephrine
Correct answer: Low-dose bupivacaine + fentanyl
Low-dose local anesthetic combined with opioid (e.g., 0.0625-0.125% bupivacaine + fentanyl 2 mcg/ml) produces effective analgesia with minimal motor blockade.
Question 7: Which physiological change in pregnancy MOST significantly affects the spread of intrathecal local anesthetic?
- Increased CSF volume
- Decreased lumbar lordosis
- Engorgement of epidural veins reducing CSF volume (Correct answer)
- Increased CSF protein
Correct answer: Engorgement of epidural veins reducing CSF volume
Epidural venous engorgement compresses the dural sac, reducing CSF volume and increasing cephalad spread of intrathecal local anesthetic.
EDAIC Obstetric Anesthesia and Analgesia 2
A parturient with severe preeclampsia requires cesarean delivery.
Which antihypertensive is CONTRAINDICATED in this setting?