General Anesthesia for Cesarean Section

General Anesthesia for Cesarean Section - General...

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General Anesthesia for General Anesthesia for Cesarean Section Cesarean Section Husong Li, M.D., Ph.D. Assistant Professor Department of Anesthesiology University of Texas Medical Branch at Galveston, Texas
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Introduction Introduction Cesarean-section (CS) deliveries have accounted for nearly 1 million of approximately 4 million annual deliveries in US. Approximately 15% of CS was performed under general anesthesia in US (Anesthesiology Hawkins, JL 1997). Majority of CS were done under urgent or emergent situations. In 2000, CS rate is about 22% in US, and 31.8% in UTMB.
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Indications for General Anesthesia Indications for General Anesthesia Fetal distress Significant coagulopathy Acute maternal hypovolemia and Homodynamic instability Sepsis or local skin infection failed regional anesthesia Maternal refusal of regional anesthesia
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Preoperative Preparation for Preoperative Preparation for General Anesthesia General Anesthesia Airway evaluation Aspiration prophylaxis Basic machine and monitor preparation
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Factors may complicate Factors may complicate endotracheal intubations endotracheal intubations Weight gain Oropharynx edema Enlarged breasts Obesity with short neck Full dentition Mallampati IV and mamdibular recession History of difficult airway
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Airway evaluation Airway evaluation Anticipation of difficult endotracheal intubation (1 in 300 in OB and 1 in 2000 all patients) Thorough examination of neck, mandible, dentition, and Oropharynx Training and experience (Hawthorne L. Br J. Anesth 1996; 76: 680-684) Sniffing position
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Airway evaluation Airway evaluation Moderate head elevation, extension of atlanto-occipital, and flexion of the lower portion of the cervical spine sniffing position
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Preparation and Prevention Preparation and Prevention 2-3 different blades, ie MAC 3&4 Miller 2 6 to 7 mm ETT tubes with stylets LMAs sizes 3 and 4 Emergency airway cart ready in the OR Fiberoptic bronchoscope Possible surgical airway equipment
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Aspiration prophylaxis Aspiration prophylaxis Pulmonary aspiration: 1 in 400-500 in OB versus 1 in 2000 in all surgical patients No agent or combination of agents can guarantee that a parturient will not aspirate or develop pneumonitis following failed intubations
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Factors increase the risk of aspiration Decrease in gastric and intestinal motility
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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General Anesthesia for Cesarean Section - General...

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