Anesthesia for C-section

Question 1

What does the choice of anesthetic depend on?

Answer 1

• Indications for surgery
• degree of urgency
• maternal status
• condition of fetus
• desires of pt

Question 2

What are the advantages of using GA for C/S?

Answer 2

• Rapid, reliable induction
• control of airway
• superior control of hemodynamics
• excellent surgical conditions
• possible in presence of coagulopathy, hemorrhage, sepsis

Question 3

What are the disadvantages of using GA for c/s?

Answer 3

• Potential for difficult or failed intubation
• unconscious patient
• aspiration
• fetal effects
• neonatal depression
• maternal awareness

Question 4

What is the process of induction when using GA for c/s?

What agents should you use?

Answer 4

• Pt does all pre-op prep before induction, while pt awake
• Preoxygenate!
• RSI w/ cricoid pressure
• Meds:
  
  • ketamine (if pt hypotensive) 1mg/kg
  • etomidate 0.3 mg/kg
  • propofol 2-2.5 mg/kg
  • succ 1-1.5 mg/kg
    
    • preferred muscle relaxant

Question 5

When does the surgeon make the incision for a c/s?

How should you ventilate?

what is the critical interval?

Answer 5

• Surgeon makes incision immediately after placement of ETT is confirmed
• Ventilate with half and half O2/N2O and small amt of VA (<1 MAC) or propofol
• Critical interval of 3 minutes between uterine incision and delivery of fetus

Question 6

What will you give the c/s patient right after delivery of baby?

How will you extubate?

Answer 6

• you will discontinue or reduce the VA, maybe increasing N2O to 70%
• give opioids or benzos
• possible NDMR
• deliver the placenta
• then can add oxytocin to help uterus contract
• Reverse NDMR
• Extubate awake!

Question 7

What is the difficult airway/fetal distress flowchart?

Answer 7

Question 8

What are the advantages of spinal anesthesia for c/s?

disadvantages?

Answer 8

• Advantages
  
  • rapid onset
  • dense and reliable anesthesia
  • minimizes risk for aspiration/failed intub
  • little risk of LA toxicity
  • minimal drug transfer to fetus
  • awake patient
  • decreased blood loss
• disadvantages
  
  • hypotension
  • limited duration of action
  • N/V

Question 9

How can you prevent hypotension when placing a spinal for c/s?

Answer 9

• LUD
• crystalloid coloading
• ephedrine (5-10 mgIV)
• phenylephrine (50-100 mcg IV)

Question 10

What are the symptoms of a total spinal?

treatment?

Answer 10

• symptoms
  
  • hypotension
  • dyspnea
  • inability to speak
  • loss of consciousness
• Treatment
  
  • intubation
  • oxygen
  • ventilation
  • support maternal hemodynamics

Question 11

What should you know about non-obstetric surgery in an OB pt?

Answer 11

• prior to viability (<24 weeks)
  
  • document FHR prior to and after procedure via doppler or US
• After viability (> 24 weeks)
  
  • admitted to L&D 2 hrs prior to surgery
  • external FHR monitoring for 30-60 minutes
  • intraoperative FHR monitoring by L&D nurse, may want delivery equipment in room
  • return to L&D post op for FHR monitoring after short stay in pacu

Question 12

What are post-anestesia concerns for pregnant patients?

Answer 12

• miscarriage
• teratogenic drugs
• breastfeeding