350 Obstetrics and Gynecology Board Review •••
❍ What is the most common complication occurring in the postanesthesia care unit?
Nausea and vomiting that occurs in 10% to 30% of patients after anesthesia.
❍ What common postoperative medication should be avoided in patients with QTc prolongation?
Ondansetron (or any of the first-generation 5-HT3 antagonists) should be avoided as they may result in the
potentially fatal cardiac arrhythmia torsades de pointes.
❍ What is the cause of postoperative hypothermia?
Anesthetic-induced vasodilation and impaired thermoregulation in conjunction with the cold environment of the
operating room.
❍ How can postoperative narcotic requirements be reduced?
Administration of local anesthetics such as bupivacaine into the surgical wound, and administration of NSAIDs
such as ketorolac may reduce overall narcotic use.
❍ Inadvertent injection of a local anesthetic into the vascular space may result in what complications?
Systemic toxicity may result in tinnitus, metallic taste, agitation, and seizure. At higher doses cardiovascular
complications may arise including bradycardia, vasodilation, AV block, ventricular arrhythmia, and cardiac
arrest.
❍ What methods of postoperative pain control are most effective?
Intraspinal anesthetics and/or narcotics administered in the epidural or intrathecal space; continuous subcutaneous
infiltration of anesthetic solution via implanted catheter.
❍ What are the advantages of epidural rather than intrathecal analgesia?
Epidural analgesia can provide extended pain relief (>24 hours), whereas intrathecal analgesia is limited to one dose
due to the risk of CNS infection, the development of headaches, and respiratory depression.
❍ What is the most serious complication associated with epidural postoperative analgesia?
Respiratory depression occurring in <1% of patients.
❍ How is a postdural puncture headache treated?
A blood patch may be performed by injecting 10 to 20 cc of the patients own blood into the epidural space to
form a clot over the dural leak.
❍ What is the mechanism of postoperative halothane-induced hepatitis?
A halothane metabolite via an autoimmune process induces the hepatitis. Risk factors include familial history and
obesity.
❍ When does halothane-induced hepatitis typically occur?
Usually 1 to 2 weeks after the exposure to halothane.
❍ What is the definition of febrile morbidity in the postoperative patient?
Temperature ≥100.4°F (38°C) on two separate occasions at least 4 hours apart excluding the first 24 hours.