Obstetric Anesthesia Practice Questions

Q: A female presents with placenta previa with active bleeding and blood pressure of 80/50 mm Hg and pulse rate of 140 bpm. The choice of anaesthesia for emergency cesarean section in this female is?

General anesthesia with intravenous ketamine. ***General anesthesia with intravenous ketamine*** - **Ketamine** maintains sympathetic tone, supporting **blood pressure** in patients with significant **hemorrhage** and **hypovolemic shock**. - Its **bronchodilatory** properties are also beneficial, making it a suitable choice for this emergency scenario where the patient is **hemodynamically unstable**. *General anesthesia with intravenous propofol* - **Propofol** can cause significant **vasodilation** and myocardial depression, which would worsen the patient's existing **hypotension** and **tachycardia**. - Its use in an actively bleeding, **hemodynamically unstable** patient is generally contraindicated due to the risk of further **cardiovascular collapse**. *Spinal anesthesia* - **Spinal anesthesia** is contraindicated in patients with significant **hypovolemia** and **active bleeding** due to the risk of severe **hypotension**. - The sympathetic blockade caused by spinal anesthesia would exacerbate the patient's already compromised **hemodynamic status**, potentially leading to **cardiac arrest**. *Epidural anesthesia* - Similar to spinal anesthesia, **epidural anesthesia** causes **sympathetic blockade** and can lead to **hypotension**, making it unsuitable for a patient with **active bleeding** and **hypovolemic shock**. - The onset of **epidural blockade** is slower than spinal, but the hemodynamic effects are still detrimental in this critically ill patient.

Q: Anesthetic agent of choice as epidural anesthesia in labour is?

Bupivacaine. ***Bupivacaine*** - **Bupivacaine** is the preferred agent for epidural anesthesia in labor due to its **long duration of action** and ability to produce good sensory block with minimal motor block. - This allows for effective pain relief during labor while preserving the mother's ability to push during delivery. *Prilocaine* - **Prilocaine** has a **shorter duration of action** and a higher risk of causing **methemoglobinemia** at doses required for effective labor epidural. - It is generally not recommended for obstetric epidural anesthesia. *Procaine* - **Procaine** is an **ester-type** local anesthetic with a very short duration of action, making it unsuitable for continuous epidural pain relief during labor. - It also has a higher incidence of **allergic reactions** compared to amide-type local anesthetics. *Lignocaine* - While **lignocaine** (lidocaine) can be used for epidural anesthesia, its **shorter duration of action** compared to bupivacaine often necessitates more frequent dosing or continuous infusion at higher concentrations. - Higher concentrations of lignocaine can lead to more significant motor block, potentially interfering with the pushing phase of labor.

Q: Best treatment for relieving pain during intrapartum period is:

Epidural anesthesia. ***Epidural anesthesia*** - Provides **continuous pain relief** during labor, allowing mobility and control over medication dosage through patient-controlled epidural analgesia (PCEA). - It is effective for both vaginal and cesarean deliveries, offering superior pain control compared to other methods while maintaining maternal consciousness. *General Anesthesia* - Involves a **complete loss of consciousness** and is primarily reserved for emergency cesarean sections due to its associated risks for both mother and baby. - It is unsuitable for routine labor pain management as it prevents maternal participation and response during delivery. *Spinal anesthesia* - Provides **rapid, intense pain relief** but is typically a single-shot injection with a shorter duration of action compared to epidural anesthesia. - It is often used for planned cesarean sections or for a rapid, profound block during the late stages of labor, but it does not allow for long-term, dynamic pain management like an epidural. *IV ketamine* - Can be used for pain relief in lower doses, but it can cause **sedation, hallucinations, and dysphoria**, which are undesirable during labor. - While it's a potent analgesic, its side effect profile makes it a less favorable choice than regional anesthesia for routine intrapartum pain relief.

Q: During cesarean section under general endotracheal anaesthesia, venous air embolism

Is associated with decreased end-tidal CO2. ***Is associated with decreased end-tidal CO2*** - Venous air embolism causes **pulmonary artery obstruction**, leading to ventilation-perfusion mismatch and decreased blood flow to the lungs. - This reduced pulmonary blood flow results in a significant **decrease in expired CO2**, as less CO2 is delivered to the alveoli for exhalation. *Induces severe hypertension* - Venous air embolism typically causes **hypotension** due to reduced cardiac output and right ventricular failure, not hypertension. - Direct effects of air in the circulation include **vasodilation** and myocardial depression, contributing to a drop in blood pressure. *Should be treated with nitrous oxide* - **Nitrous oxide** should be avoided in cases of venous air embolism as it expands gas-filled spaces, potentially increasing the size of the air embolus and worsening patient outcomes. - Treatment involves 100% oxygen, Trendelenburg position, left lateral decubitus, and aspiration of air from the right atrium, not the administration of additional gas. *Is associated with high end-tidal CO2* - A high end-tidal CO2 would indicate improved ventilation or perfusion, which is contrary to the effects of a venous air embolism that **reduces pulmonary blood flow** and thus CO2 exchange. - The hallmark respiratory sign of venous air embolism is a **sudden profound decrease in end-tidal CO2** due to arterial obstruction.

Q: A 30 year old woman with coarctation of aorta is admitted to the labour room for elective caesarean section. Which of the following is the anaesthesia technique of choice -

General anaesthesia. ***General anaesthesia*** - In patients with **coarctation of the aorta**, general anaesthesia is often preferred for caesarean section to maintain **hemodynamic stability** and carefully control **cardiovascular responses**. - Rapid changes in blood pressure and heart rate associated with regional anaesthesia can increase the risk of **aortic dissection** or **rupture** due to the stress on the weakened aorta. *Epidural anaesthesia* - While epidural anaesthesia offers **gradual onset** and titration, the controlled hypotension it induces can still be risky in coarctation patients if not managed meticulously. - The potential for **sympathetic blockade** and associated blood pressure changes might compromise perfusion to vital organs distal to the coarctation. *Spinal anaesthesia* - **Spinal anaesthesia** causes a rapid and profound sympathetic blockade, leading to a sudden drop in systemic vascular resistance and blood pressure. - This abrupt change significantly increases the risk of **aortic dissection** or severe **hypotension** distal to the coarctation, making it highly dangerous for this patient population. *Local anaesthesia with nerve blocks* - **Local anaesthesia** with nerve blocks alone is generally insufficient for a caesarean section, as it would not provide adequate surgical anaesthesia or uterine muscle relaxation. - While it has minimal systemic hemodynamic effects, its inadequacy for the surgical procedure itself makes it an impractical choice for coarctation patients undergoing caesarean section.

Q: Anesthesia of choice for cesarean section in severe preeclampsia:-

Spinal. ***Spinal*** - **Spinal anesthesia** is generally preferred in severe preeclampsia because it provides **rapid onset** of dense block, which can be critical for emergent cesarean sections. - It avoids the risks associated with general anesthesia in these patients, such as difficult intubation and exaggerated **hypertensive response** to laryngoscopy. *GA* - **General anesthesia (GA)** in severe preeclampsia carries increased risks due to **airway edema**, potential for difficult intubation, and significant **blood pressure fluctuations** during induction and intubation. - It can exacerbate the already compromised uteroplacental perfusion due to the sympathetic blockade and the potential for a **hypotensive episode**. *Epidural* - While generally safe in less severe preeclampsia, an **epidural** has a **slower onset** compared to spinal anesthesia, which may be a disadvantage in emergent situations. - The gradual sympathetic blockade with an epidural is often preferred to avoid sudden drops in blood pressure, but the delay in achieving a surgical block might not be acceptable in severe, unstable cases. *Combined spinal-epidural (CSE)* - **Combined spinal-epidural (CSE)** offers the rapid onset of a spinal block with the flexibility of an epidural catheter for prolonged anesthesia or postoperative pain control. - However, in cases of severe preeclampsia where **hemodynamic instability** is a major concern, the relatively larger dose of local anesthetic required for epidural component can lead to a more pronounced or rapid drop in blood pressure.

Q: In a patient undergoing a cesarean section under spinal anesthesia, what is the most likely cause of severe headache postoperatively?

Post-dural puncture headache. ***Post-dural puncture headache*** - This is the most common cause of severe headache following **spinal or epidural anesthesia**, due to **CSF leakage** through the dural puncture site. - The headache is typically **postural**, worsening when upright and improving with lying down. *Hypotension* - While hypotension can be a side effect of spinal anesthesia, it generally manifests as **dizziness, nausea, or syncope**, rather than a severe, isolated headache. - Though it can contribute to *cerebral hypoperfusion*, it does not directly cause the characteristic **postural headache** seen with PDPH. *Hypertension* - **Hypertensive headaches** are usually generalized, pulsating, and may be accompanied by visual changes, but they are not specifically linked to the spinal anesthesia itself in this context. - Postoperative hypertension is not a typical complication of spinal anesthesia and does not cause a *postural headache*. *Dehydration* - **Dehydration** can cause a generalized headache, but it is usually mild to moderate and non-postural. - It would not typically result in the severe, characteristic **postural headache** experienced after a dural puncture.

Q: A 30-year-old female in her third trimester of pregnancy presents for emergency surgery requiring immediate intervention. What is the most appropriate anesthetic plan for this patient?

General anesthesia with rapid sequence induction. ***General anesthesia with rapid sequence induction*** - **Rapid sequence induction (RSI)** is crucial in pregnant patients due to **increased risk of aspiration** from delayed gastric emptying and increased intra-abdominal pressure. - An emergency surgery requiring **immediate intervention** precludes the time needed for regional anesthesia to take full effect and ensures optimal fetal monitoring and management. *Spinal anesthesia with low-dose bupivacaine* - While spinal anesthesia is a common choice for *elective* C-sections, it may not be suitable for **emergency surgery requiring immediate intervention** due to the time lag in onset and potential for maternal hypotension, which can compromise fetal oxygenation. - **Low-dose bupivacaine** might not provide adequate surgical anesthesia rapidly enough for an emergent procedure, and the urgency often necessitates a quicker onset. *Epidural anesthesia with continuous infusion* - Epidural anesthesia has a **slower onset** compared to spinal or general anesthesia, making it inappropriate for an emergency situation requiring immediate intervention. - A **continuous infusion** is better suited for prolonged procedures or labor analgesia, not for an urgent surgical start. *Regional anesthesia with minimal sedation* - **Regional anesthesia** in general, including spinals and epidurals, takes time to administer and achieve full effect, which may not be compatible with the need for immediate surgical intervention. - **Minimal sedation** might be insufficient if the patient is anxious or if the surgical field is extensive or requires deep tissue manipulation, which can lead to patient discomfort and movement.

Q: What is the preferred position for a patient undergoing spinal anesthesia for a cesarean section?

Lateral decubitus. ***Lateral decubitus*** - The **lateral decubitus position** (left or right side-lying) is commonly preferred for spinal anesthesia in pregnant women. - This position helps prevent **aortocaval compression**, which can occur in the supine position due to the gravida uterus compressing the great vessels. *Supine* - The **supine position** is generally avoided for spinal anesthesia in pregnant women due to the risk of **aortocaval compression**. - This compression can lead to **maternal hypotension** and reduced placental perfusion, posing risks to both mother and fetus. *Trendelenburg* - The **Trendelenburg position** involves placing the patient head-down. - While it can be used in some situations to manage hypotension, it is **not the preferred initial position** for administering spinal anesthesia, especially in pregnant patients. *Sitting* - The **sitting position** can be used for spinal anesthesia, as it allows for easy identification of the intervertebral spaces due to **flexion of the lumbar spine**. - However, for pregnant women, it may be less comfortable and still carries some risk of **hypotension** if not carefully managed.

Q: A 30-year-old pregnant woman is scheduled for an elective cesarean section. Which inhalational agent has the least effect on uteroplacental blood flow?

Isoflurane. ***Isoflurane*** - Isoflurane causes **minimal suppression of uterine contractions** and has the **least effect on uteroplacental blood flow** compared to other volatile anesthetics, making it suitable for pregnant patients. - Its **low solubility** allows for rapid emergence, which is beneficial for maternal-fetal well-being. *Desflurane* - Desflurane, while having a very **low blood-gas solubility** and rapid onset/offset, can cause a **higher incidence of maternal hypertension and tachycardia**, potentially compromising uteroplacental blood flow. - Its tendency to cause a more pronounced **sympathetic response** makes it less ideal for maintaining stable uteroplacental perfusion compared to isoflurane. *Nitrous oxide* - While nitrous oxide is often used in obstetric anesthesia, it provides **poor uterine relaxation** and can lead to **diffusional hypoxia** in the mother if not appropriately managed during emergence. - It's typically used as an adjunct to other agents rather than a sole anesthetic, and in higher concentrations, it can still negatively impact uteroplacental circulation. *Sevoflurane* - Sevoflurane provides **good uterine relaxation** and smooth induction, but it tends to cause **more uterine atony** and bleeding compared to isoflurane at equipotent concentrations. - Its **higher impact on uterine tone** can compromise uteroplacental blood flow more significantly than isoflurane, especially during the maintenance phase.

Question 1

A female presents with placenta previa with active bleeding and blood pressure of 80/50 mm Hg and pulse rate of 140 bpm. The choice of anaesthesia for emergency cesarean section in this female is?

Accepted Answer

General anesthesia with intravenous ketamine

Answer

General anesthesia with intravenous propofol

Answer

Spinal anesthesia

Answer

Epidural anesthesia

Question 2

Anesthetic agent of choice as epidural anesthesia in labour is?

Accepted Answer

Bupivacaine

Answer

Prilocaine

Answer

Procaine

Answer

Lignocaine

Question 3

Best treatment for relieving pain during intrapartum period is:

Accepted Answer

Epidural anesthesia

Answer

General Anesthesia

Answer

Spinal anesthesia

Answer

IV ketamine

Question 4

During cesarean section under general endotracheal anaesthesia, venous air embolism

Accepted Answer

Is associated with decreased end-tidal CO2

Answer

Induces severe hypertension

Answer

Should be treated with nitrous oxide

Answer

Is associated with high end-tidal CO2

Question 5

A 30 year old woman with coarctation of aorta is admitted to the labour room for elective caesarean section. Which of the following is the anaesthesia technique of choice -

Accepted Answer

General anaesthesia

Answer

Epidural anaesthesia

Answer

Spinal anaesthesia

Answer

Local anaesthesia with nerve blocks

Question 6

Anesthesia of choice for cesarean section in severe preeclampsia:-

Accepted Answer

Spinal

Answer

GA

Answer

Epidural

Answer

Combined spinal-epidural (CSE)

Question 7

In a patient undergoing a cesarean section under spinal anesthesia, what is the most likely cause of severe headache postoperatively?

Accepted Answer

Post-dural puncture headache

Answer

Hypotension

Answer

Hypertension

Answer

Dehydration

Question 8

A 30-year-old female in her third trimester of pregnancy presents for emergency surgery requiring immediate intervention. What is the most appropriate anesthetic plan for this patient?

Accepted Answer

General anesthesia with rapid sequence induction

Answer

Spinal anesthesia with low-dose bupivacaine

Answer

Regional anesthesia with minimal sedation

Answer

Epidural anesthesia with continuous infusion

Question 9

What is the preferred position for a patient undergoing spinal anesthesia for a cesarean section?

Accepted Answer

Lateral decubitus

Answer

Supine

Answer

Trendelenburg

Answer

Sitting

Question 10

A 30-year-old pregnant woman is scheduled for an elective cesarean section. Which inhalational agent has the least effect on uteroplacental blood flow?

Accepted Answer

Isoflurane

Answer

Desflurane

Answer

Nitrous oxide

Answer

Sevoflurane

Obstetric Anesthesia — MCQs

Obstetric Anesthesia — MCQs

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