Obstetric Anesthesia Pdf
The primary concern during nonobstetric surgery during pregnancy is always the safety of the mother. In the early to mid second trimester, procedures requiring anesthesia include insertion of cervical suture for incompetent cervix, and an array of nonobstetric operations and procedures e. Anesthesia providers must recognize the anesthetic implications of this altered physiology in order to care for patients throughout the puerperium, sony nx720 manual pdf as well as during non-obstetric surgery.
Neuraxial or general anesthesia will exaggerate these hemodynamic effects. Reprinted with permission from Olofsson C, et al.
The surgical team should likewise be gowned and gloved, and ready to start as soon as the airway is secured. The most commonly described events are sounds, conversation and tactile sensations e. Respiratory Depression Shortly after the introduction of epidural morphine to clinical use, respiratory depression was recognized as a potentially serious complication. Similar mechanisms may apply for failure of spinal anesthesia. In most cases they do not require treatment.
The D-isomer binds cardiac sodium channels more tightly than the L-isomer, and is consequently more cardiotoxic. The ventral lamina are associated primarily with motor neurons. These changes occur in early pregnancy and increase in incidence until term gestation.
Thus the advent of obstetric anesthesia facilitated the use of instruments during delivery as obstetricians were afforded greater scope in terms of these materials. Anesthesia for Removal of Retained Products of Conception This is an occasion of considerable emotional disturbance for many women, so general anesthesia is normally preferred.
The next synapse occurs, appropriately enough, in the thalamus. This event probably arises from rapid systemic uptake or intravascular injection of the drug. Thyroid Although there is an elevation of total serum thyroxin during gestation, and the thyroid gland is often noted to be enlarged, a euthyroid clinical state is maintained throughout pregnancy. The inhalation of anesthetic agents do not affect the act of labor or the mechanism by which uterine contractions occur, but rather renders the woman insensible to the high degree of pain.
Elizabeth Kiernan for her endless help in completing the new edition. It is likely due to rapid systemic uptake or rapid cephalad distribution within the central nervous system and, may be more likely following repeat doses. Like fentanyl, a short duration limits the usefulness of sufentanil as a postoperative analgesic.
Because low doses of bupivacaine are most appropriate for sequential approaches, it is essential to include adjuncts, most commonly a lipophilic opioid. It is not clinically useful given the high frequency of microemboli. As a consequence, relatively large gauge epidural catheters must be used for continuous spinal techniques and these catheters increase the likelihood of a post-dural puncture headache. Although the exact mechanism is unknown, chloroprocaine reduces fentanyl and morphine analgesia, even after the block has receded. From Wikipedia, the free encyclopedia.
Common Problems In Obstetric Anesthesia
The best position in which to place the patient is unknown and controversial. In rare instances, the application of topical local anesthetic cream, if time allows, may be helpful. Despite remodeling, contractility is probably unchanged. Meperidine pethidine was introduced in the s and was promoted as having minimal respiratory depressant effects. During early pregnancy, the teratogenic and carcinogenic potential of anesthetic or sedative drugs assumes particular importance.
Some recent in vitro investigations have called into question this traditional understanding. Includes bibliographical references and index. Sufentanil Like fentanyl, the major advantage of epidural sufentanil over epidural morphine is its rapid onset. The patient should be aware that.
It is not currently recommended for routine clinical use in obstetrics. It has been associated with neurologic injury when administered intrathecally.
This is not intended to be an exhaustive reference textbook, although the readings and references at the end of each chapter do provide additional background and the basis for further study. Neostigmine Neostigmine is the only anticholinesterase that has been systematically investigated as a neuraxial labor analgesic in humans to date. Spinal anesthesia is also appropriate and minimizes the concentration of anesthetic in follicles. Perioperative analgesia with subarachnoid fentanyl bupivacaine for cesarean delivery. Uterine vessels are maximally vasodilated.
Seminars in Anesthesia, Perioperative Medicine and Pain. While visually appealing, it was more at home on a bookshelf than in the pocket of a scrub suit or on an anesthesia cart. Unfortunately, each adjunct studied e.
Nausea and Vomiting Treatment options for nausea and vomiting include antiemetics and opioid antagonists. Vacuum deliveries generally require anesthetic levels similar to those of low and outlet forceps. Presynaptically, opioid agonists result in decreased release of neurotransmitters by the primary afferent. Attention to maternal blood pressure and heart rate is fundamental during anesthesia for cesarean delivery. Interneurons project between lamina and levels of the gray matter.
Opioids Almost all neuraxially administered opioids are analgesic. Nitrous oxide is a useful adjunct, reducing inhalational anesthetic and analgesic requirements, and has no disadvantages after short periods of administration. This is the physiochemical basis for the addition of bicarbonate to epidural local anesthetics to speed their action. Specific consent from the patient should be obtained before administration because of potential oversedation and the undesirable psychomimetic effects.
Textbook Of Obstetric Anesthesia
This has the effect of extending the duration of a single injection of morphine. This block is also rarely used now.
Cautiously approaching the epidural space and inserting the epidural needle using a horizontal, cephalad orientation minimizes the incidence of unintended dural puncture. Although not all women require evacuation of retained products of conception, this is a very common operation for which general anesthesia is usually provided. Bradycardia may follow repeat administration. Meperidine for patient-controlled analgesia after cesarean section. Interactions between noradrenergic and cholinergic mechanisms involved in spinal nociceptive processing.
The patient should be warned about possible dental and soft tissue injury. Muscarinic cholinergic receptors are found in the gray matter of the dorsal horn of the spinal cord. Caution must be used when administering opioids, as repeat doses may increase the risk of respiratory depression.
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