NM704 EXAM 4 QUESTIONS AND ANSWERS WITH COMPLETE
VERIFIED SOLUTIONS LATEST UPDATE
Epidural: Mode of Action
when an anesthetic drug is placed in the epidural space, impulses traveling in the
sensory and motor nerves in contact with the drug are blocked
Epidural: Benefits
most effective pain relief, high levels of satisfaction
Epidural: Contraindications
Absolute contraindication: declining an epidural, inability to cooperate for placement,
skin or soft tissue infection at site of needle placement, frank coagulopathy, untreated
sepsis, maternal hemoinstability.
Relative contraindications: coagulopathy, thrombocytopenia, space occupying brain
lesion, heparin therapy, neurologic disease of spinal cord
Epidural: Effects on baby
FHR decels d/t decreased blood flow to uterus. Anesthetic drugs and opioids lipid
soluble - may cross BBB, but depends on concentration in maternal blood. Poor 5 min
Apgars and low umbilical artery pH similar between epidural and no epidural. No
neurological differences observed.
Epidural: Relationship to maternal fever
Relationship to intrapartum maternal fever: increase in incidence demonstrated w/
epidurals. Fever over 100.4 can occur after approx. 4 hours (based on trend of
,elevation). R/t decrease in heat dissipation through sweating d/t sympathetic block OR
may indicate chorio. Must be treated for chorio, infant must have sepsis work up.
Epidural: Possible Complications
Postprocedural puncture headache, back pain (unknown etiology). Adverse effects to
performance: epidural abscess, hematoma, neuro injury, total spinal anesthesia. SE of
anesthetic: hypotension, urinary retention/bladder distension, leg numbness and
weakness. Associated w/ prolonged second stage, increase in operative vaginal births,
no increase in cesarean rates
Demerol (timing of administration and side effx)
Demerol generally is not recommended for peripartum analgesia because its active
metabolite, normeperidine, has a prolonged half-life in adults and a half-life of up to 72
hours in the neonate; the normeperidine effect cannot be antagonized by naloxone
Morphine (timing of administration and side effx)
Crosses the placenta and may have adverse effects for the fetus or newborn. This may
be reflected in loss of variability in the fetal heart rate (FHR), reduction in the FHR
baseline, neonatal respiratory depression, or neurobehavioral changes. Drug
elimination takes longer in newborns than in adults, so effects may be prolonged,
particularly if administered near the time of delivery.
Nubain (timing of administration and side effx)
Nalbuphine and butorphanol are mixed agonist-antagonists and, therefore, are
associated with less respiratory depression for an equianalgesic dose. May trigger
withdrawal symptoms or reduce analgesic effects in those receiving opioid agonist
therapy.
, Stadol (timing of administration and side effx)
Maternal ceiling effect on respiratory depression and analgesia. Fetal transient pseudo-
sinusoidal FHR. May precipitate acute withdrawal syndrome in opiate-dependent
mother and baby.
Fentanyl (timing of administration and side effx)
Short acting; less effective than morphine or Demerol, but very few side effects noted.
With higher doses or prolonged infusions, becomes longer lasting. Transient decreased
FHR variability or pseudo-sinusoidal pattern.
Remifentanil (timing of administration and side effx)
Remifentanil is an ultra-short-acting opioid without active metabolites. Its
pharmacokinetics allow for easy titration during labor and for less risk of respiratory
depression in the newborn. Administered by PCA, better relief than other opioids
What components should be monitored to evaluate the well-being of mother and
baby during 2nd stage of labor?
Vital signs, FHR, nutrition and hydration, bladder distention, pain/comfort, coping, level
of fatigue
How often should mom's vital signs be assessed in second stage labor?
BP: q15 min (check between contractions)
Temp, pulse, RR: q60 min
How often should fetal heart rate be assessed in second stage labor?
q5-15 min, increase frequency as presenting part descends
VERIFIED SOLUTIONS LATEST UPDATE
Epidural: Mode of Action
when an anesthetic drug is placed in the epidural space, impulses traveling in the
sensory and motor nerves in contact with the drug are blocked
Epidural: Benefits
most effective pain relief, high levels of satisfaction
Epidural: Contraindications
Absolute contraindication: declining an epidural, inability to cooperate for placement,
skin or soft tissue infection at site of needle placement, frank coagulopathy, untreated
sepsis, maternal hemoinstability.
Relative contraindications: coagulopathy, thrombocytopenia, space occupying brain
lesion, heparin therapy, neurologic disease of spinal cord
Epidural: Effects on baby
FHR decels d/t decreased blood flow to uterus. Anesthetic drugs and opioids lipid
soluble - may cross BBB, but depends on concentration in maternal blood. Poor 5 min
Apgars and low umbilical artery pH similar between epidural and no epidural. No
neurological differences observed.
Epidural: Relationship to maternal fever
Relationship to intrapartum maternal fever: increase in incidence demonstrated w/
epidurals. Fever over 100.4 can occur after approx. 4 hours (based on trend of
,elevation). R/t decrease in heat dissipation through sweating d/t sympathetic block OR
may indicate chorio. Must be treated for chorio, infant must have sepsis work up.
Epidural: Possible Complications
Postprocedural puncture headache, back pain (unknown etiology). Adverse effects to
performance: epidural abscess, hematoma, neuro injury, total spinal anesthesia. SE of
anesthetic: hypotension, urinary retention/bladder distension, leg numbness and
weakness. Associated w/ prolonged second stage, increase in operative vaginal births,
no increase in cesarean rates
Demerol (timing of administration and side effx)
Demerol generally is not recommended for peripartum analgesia because its active
metabolite, normeperidine, has a prolonged half-life in adults and a half-life of up to 72
hours in the neonate; the normeperidine effect cannot be antagonized by naloxone
Morphine (timing of administration and side effx)
Crosses the placenta and may have adverse effects for the fetus or newborn. This may
be reflected in loss of variability in the fetal heart rate (FHR), reduction in the FHR
baseline, neonatal respiratory depression, or neurobehavioral changes. Drug
elimination takes longer in newborns than in adults, so effects may be prolonged,
particularly if administered near the time of delivery.
Nubain (timing of administration and side effx)
Nalbuphine and butorphanol are mixed agonist-antagonists and, therefore, are
associated with less respiratory depression for an equianalgesic dose. May trigger
withdrawal symptoms or reduce analgesic effects in those receiving opioid agonist
therapy.
, Stadol (timing of administration and side effx)
Maternal ceiling effect on respiratory depression and analgesia. Fetal transient pseudo-
sinusoidal FHR. May precipitate acute withdrawal syndrome in opiate-dependent
mother and baby.
Fentanyl (timing of administration and side effx)
Short acting; less effective than morphine or Demerol, but very few side effects noted.
With higher doses or prolonged infusions, becomes longer lasting. Transient decreased
FHR variability or pseudo-sinusoidal pattern.
Remifentanil (timing of administration and side effx)
Remifentanil is an ultra-short-acting opioid without active metabolites. Its
pharmacokinetics allow for easy titration during labor and for less risk of respiratory
depression in the newborn. Administered by PCA, better relief than other opioids
What components should be monitored to evaluate the well-being of mother and
baby during 2nd stage of labor?
Vital signs, FHR, nutrition and hydration, bladder distention, pain/comfort, coping, level
of fatigue
How often should mom's vital signs be assessed in second stage labor?
BP: q15 min (check between contractions)
Temp, pulse, RR: q60 min
How often should fetal heart rate be assessed in second stage labor?
q5-15 min, increase frequency as presenting part descends
