EDAIC Obstetric Anesthesia and Analgesia 5 — Questions and Answers
Question 1: During emergent cesarean section under general anesthesia, which sequence correctly follows rapid sequence induction?
- Mask ventilate, intubate, confirm, proceed
- Preoxygenate, cricoid pressure, induction agent, succinylcholine, intubate without ventilation (Correct answer)
- Induction agent, rocuronium, mask ventilate, intubate
- Cricoid pressure, preoxygenate, induction agent, intubate
Correct 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.
Question 2: Uterotonic oxytocin given as an IV bolus during cesarean section can cause which serious hemodynamic effect?
- Hypertension and bradycardia
- Severe hypotension and tachycardia (Correct answer)
- No hemodynamic effects
- Pulmonary hypertension
Correct 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.
Question 3: Which finding on fetal heart rate monitoring during epidural analgesia initiation MOST warrants emergent delivery?
- Early decelerations
- Moderate variability with accelerations
- Prolonged bradycardia below 80 bpm lasting >3 minutes (Correct answer)
- Late decelerations with good variability
Correct 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.
Question 4: What is the recommended approach when a 'walking epidural' technique is desired for labor analgesia?
- High-concentration bupivacaine without opioid
- Low-dose bupivacaine 0.0625% with intrathecal fentanyl via CSE (Correct answer)
- Epidural morphine alone
- Epidural lidocaine 2% with epinephrine
Correct 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.
Question 5: A parturient with antiphospholipid syndrome on therapeutic low-molecular-weight heparin presents for delivery. When is neuraxial anesthesia safe to perform?
- Immediately after stopping LMWH
- 4 hours after the last dose
- 12 hours after prophylactic or 24 hours after therapeutic LMWH dose (Correct answer)
- Never safe with LMWH use
Correct 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.
Question 6: Which statement about intrathecal morphine for postcesarean analgesia is CORRECT?
- Onset is immediate due to high lipid solubility
- Standard dose is 0.1-0.2 mg with peak effect at 6-8 hours (Correct answer)
- It causes no respiratory depression beyond 2 hours
- It provides inferior analgesia compared to epidural fentanyl
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.
Question 7: Which maternal condition is an absolute contraindication to neuraxial anesthesia for labor and delivery?
- Previous back surgery
- Platelet count of 90,000/μL
- Patient refusal (Correct answer)
- Gestational hypertension without coagulopathy
Correct answer: Patient refusal
Patient refusal is an absolute contraindication to any anesthetic procedure; all other listed conditions represent relative contraindications requiring individualized risk assessment.
EDAIC Obstetric Anesthesia and Analgesia 5
During emergent cesarean section under general anesthesia, which sequence correctly follows rapid sequence induction?