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Quizzes > Health & Medicine > Human Anatomy & Medicine

OB Crisis General Anesthesia Quiz: Are You a Bicitrate Pro?

Think you can ace obstetric anesthesia crisis and C-section protocols? Take the test now!

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art illustration for scored quiz on bicitrate and obstetric anesthesia prep for C section on teal background

Use this quiz to practice bicitrate use in obstetric anesthesia - timing, dose, and how it reduces aspiration risk before C‑section or during a general anesthesia crisis. Answer case‑based items and get a score so you can spot gaps fast and feel ready for your next call or exam.

What is the primary effect of sodium citrate (Bicitra) when administered preoperatively?
Increases gastric pH by neutralizing hydrochloric acid
Inhibits pepsin secretion
Reduces overall gastric volume
Stimulates gastric motility
Sodium citrate is an antacid that neutralizes gastric hydrochloric acid, thereby raising gastric pH. It does not affect gastric volume or motility directly. This pH increase helps reduce the severity of chemical pneumonitis if aspiration occurs.
In obstetric anesthesia, why is Bicitra given before a C-section under general anesthesia?
To manage gestational hypertension
To treat intraoperative nausea after spinal block
To prevent postoperative ileus
To reduce risk of Mendelson's syndrome by alkalinizing gastric contents
Bicitra is part of aspiration prophylaxis for pregnant patients undergoing general anesthesia, as gastric aspiration can cause Mendelson's syndrome. By increasing gastric pH, it lessens the severity of acid injury if aspiration occurs. It is not used for blood pressure control, nausea from spinal, or ileus prevention.
What is the standard adult dose of 0.3 M sodium citrate solution before induction of anesthesia for a C-section?
60 ml
30 ml
45 ml
15 ml
The recommended dose of 0.3 M sodium citrate (Bicitra) is 30 ml administered 15 - 30 minutes before induction. This volume effectively raises gastric pH without causing significant discomfort or risk of regurgitation. Lower or higher volumes are not standard practice.
In which of the following patients should you exercise caution when administering sodium citrate?
Patient with chronic renal failure and hypernatremia
Patient with diabetic gastroparesis
Patient with stable asthma
Patient receiving a low-residue diet
Sodium citrate contains a high sodium load and can exacerbate hypernatremia in patients with renal failure. Diabetic gastroparesis, dietary factors, or asthma do not directly contraindicate its use. Monitoring electrolytes is essential in renal impairment.
Approximately how long after oral administration does sodium citrate produce its maximal increase in gastric pH?
60 - 90 minutes
5 - 7 minutes
10 - 15 minutes
30 - 45 minutes
Sodium citrate typically acts within 10 - 15 minutes, producing its maximal alkalinizing effect on gastric contents. Onset is faster than H2-blockers or PPIs. Administering too early or too late can reduce its efficacy at induction.
Which additional medication is commonly used with Bicitra to reduce gastric volume before induction?
Ondansetron
Misoprostol
Sucralfate
Metoclopramide
Metoclopramide is a prokinetic agent that accelerates gastric emptying, reducing residual volume. Sucralfate and misoprostol do not alter volume before surgery, and ondansetron is an antiemetic without prokinetic effect. Combining Metoclopramide with Bicitra optimizes aspiration prophylaxis.
Which statement best describes the difference between sodium citrate and H2-receptor antagonists in aspiration prophylaxis?
Sodium citrate neutralizes acid but does not reduce gastric volume, H2 blockers reduce acid secretion and volume over hours
Both agents have identical onset and effects
H2 blockers act instantly, sodium citrate takes hours
Sodium citrate reduces gastric volume and pH, H2 blockers only increase pH
Sodium citrate neutralizes existing acid quickly without altering volume. H2 antagonists decrease acid production and reduce volume, but require 60 - 90 minutes to reach full effect. Their pharmacodynamics are complementary in aspiration prophylaxis.
What potential complication can be mitigated by administering Bicitra before general anesthesia induction?
Occurrence of postoperative cognitive dysfunction
Risk of pulmonary embolism
Severity of chemical pneumonitis if aspiration occurs
Incidence of postoperative urinary retention
By alkalinizing gastric contents, sodium citrate reduces acid-related lung injury in the event of aspiration, thus lowering the severity of chemical pneumonitis. It does not affect embolic risk, urinary retention, or cognitive outcomes.
According to aspiration risk guidelines, which combination of gastric pH and volume parameters is considered acceptable to minimize pulmonary injury?
pH > 3.5 and volume < 100 ml
pH > 1.5 and volume < 50 ml
pH > 2.5 and volume < 25 ml
pH > 4.5 and volume < 150 ml
Guidelines suggest that maintaining gastric pH above 2.5 and volume under 25 ml significantly reduces the severity of aspiration pneumonitis. Higher volume or lower pH are associated with increased pulmonary injury risk. This threshold guides use of antacids, H2 blockers, and prokinetics in high-risk patients.
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Study Outcomes

  1. Understand bicitrate's pharmacologic properties -

    Gain insight into how bicitrate reduces aspiration risk and its timing within obstetric anesthesia protocols.

  2. Apply evidence-based bicitrate dosing -

    Implement accurate bicitrate premedication guidelines for both emergency and elective C-section anesthesia protocols.

  3. Analyze airway management and oxygenation strategies -

    Examine critical ventilation techniques during general anesthesia obstetric crisis scenarios to enhance safety.

  4. Evaluate cesarean delivery anesthesia workflows -

    Assess protocol steps to streamline decision-making and improve maternal-fetal outcomes under pressure.

  5. Implement structured crisis response steps -

    Adopt systematic approaches to manage obstetric anesthesia emergencies and optimize patient outcomes.

  6. Identify bicitrate-related complications -

    Recognize potential adverse effects of bicitrate use and integrate mitigation strategies into cesarean delivery anesthesia planning.

Cheat Sheet

  1. Mechanism of Action of Bicitrate -

    Bicitrate combines sodium citrate and citric acid to neutralize gastric acid, raising pH above 3.5 and reducing aspiration pneumonitis risk in obstetric anesthesia (ASA Guidelines, 2017). The buffering reaction follows: H+ + Citr3− → HCit2−, which you can recall with the mnemonic "Citr - Acid Shield."

  2. Recommended Dosing and Timing -

    The standard obstetric anesthesia protocol administers 30 mL of 0.3 M bicitrate orally 15 - 30 minutes before induction to ensure peak pH effect at laryngoscopy (Obstetric Anesthesia Textbook, 2020). Practice recalling "30 by 30" (30 mL in 30 min) to lock in the correct dosing window.

  3. Integration with Fasting Guidelines -

    Current ASA fasting guidelines allow clear fluids until 2 hours pre-op, with bicitrate as the last oral intake; this "last sip" strategy bridges the gap for cesarean delivery anesthesia safety. Remember: solids 6 - 8 hrs, clear fluids 2 hrs, bicitrate just before you walk in.

  4. Role in Rapid Sequence Induction (RSI) -

    During a general anesthesia obstetric crisis, bicitrate primes the stomach while you prepare RSI with cricoid pressure, rapid-onset opioids, and succinylcholine (Journal of Clinical Anesthesia, 2019). Use the "SOAP-ME" mnemonic (Suction, Oxygen, Airway, Pressure, Meds, Equipment) to streamline your crisis protocol.

  5. Monitoring and Safety Considerations -

    While bicitrate is generally safe, watch for electrolyte shifts - especially hypernatremia - and maintain capnography and SpO₂ monitoring throughout C-section anesthesia protocols. Reviewing arterial blood gas values post-induction can confirm effective buffering and guide further management.

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