Obstetric Anesthesia & Analgesia Flashcards
7 cards from real BCA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Obstetric Anesthesia & Analgesia flashcards as text
Which physiologic change of pregnancy MOST significantly alters the pharmacokinetics of epidurally administered drugs?
Answer: Increased epidural venous engorgement reducing epidural space volume
Engorgement of the epidural venous plexus from IVC compression reduces epidural space volume, causing wider spread of local anesthetic and requiring dose reduction in late pregnancy.
A patient with placenta accreta spectrum is undergoing planned cesarean hysterectomy. The preferred anesthetic technique for anticipated massive hemorrhage is:
Answer: General anesthesia with arterial line and large-bore IV access
General anesthesia is preferred for placenta accreta spectrum cases due to anticipated massive hemorrhage requiring airway control, large blood product administration, and hemodynamic management.
Post-dural puncture headache in obstetric patients is BEST characterized by which feature?
Answer: Frontal or occipital headache that improves supine and worsens upright
PDPH is a postural headache—typically bilateral frontal/occipital—that worsens in the upright position due to CSF loss reducing intracranial support of pain-sensitive structures.
When performing an epidural blood patch for PDPH, what volume of autologous blood is typically injected?
Answer: 20-30 mL or until back/neck pressure
Epidural blood patch typically uses 20–30 mL of autologous blood; injection is stopped at 20 mL if the patient reports significant back, neck, or radicular pain.
Which physiologic change of pregnancy increases the risk of rapid oxygen desaturation during apnea in the obstetric patient?
Answer: Increased FRC combined with increased oxygen consumption
Decreased FRC (from diaphragm elevation) combined with increased maternal oxygen consumption results in rapid oxygen desaturation during apnea, necessitating careful pre-oxygenation.
Uterine atony refractory to oxytocin is BEST treated next with which agent?
Answer: Carboprost tromethamine 0.25 mg IM
Carboprost (15-methyl PGF2α) 0.25 mg IM is a second-line uterotonic for oxytocin-refractory atony; it is contraindicated in severe asthma due to bronchospasm risk.
In a patient with severe mitral stenosis presenting for labor, which anesthetic approach BEST maintains hemodynamic stability?
Answer: Slow incremental epidural analgesia to avoid acute SVR reduction
Slow titration of epidural analgesia minimizes acute drops in SVR; mitral stenosis patients require maintained sinus rhythm and preload, making abrupt sympathectomy dangerous.