ObstetricalAnesthesia

ObstetricalAnesthesia - AnesthesiafortheObstetrical Patient...

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Anesthesia for the Obstetrical  Patient Fred Rotenberg, MD Dept. of Anesthesiology Rhode Island Hospital Grand Rounds February 27, 2008
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Anesthesia for the Obstetrical Patient The Pregnant Patient for Nonobstetric Surgery LABOR DELIVERY OBSTETRICAL EMERGENCIES SPINAL HEADACHES AND BLOOD PATCHES
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Alterations in Maternal Physiology Respiratory Increased O2 consumption Decreased FRC and pCO2 (increased MV) Cardiovascular Increased blood volume and CO Dilutional anemia Possible aorto-caval compression (when supine) GI Reduced gastroesophogeal tone Reduced anesthetic requirements (both GA & regional)
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Anesthesia for the pregnant patient  undergoing non-obstetric surgery
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THE OBVIOUS AVOID MATERNAL HYPOXIA  AND HYPOTENSION
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THE NOT SO OBVIOUS Prevention / Treatment of preterm labor Probably NOT related to anesthetic management Due to SURGERY and/or underlying pathology Tocolytics (indocin or MAGNESIUM, hi dose volatile  anesthetics) Teratogenic effects of anesthetics Benzodiazepenes? Nitrous oxide? NO GOOD EVIDENCE re: risk in humans
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THE NOT SO OBVIOUS - continued Dose dependent effect of general anesthetics on  fetal or newborn animals -  Apoptotic neurodegeneration Persistent memory/learning impairments Therefore: USE AS LITTLE GENERAL  ANESTHETIC (iv and volatile) as possible
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If possible delay surgery til 2 nd  trimester Less risk of teratogenicity, miscarriage, than 1 st  trimester preterm labor more likely in 3 rd  trimester Left uterine displacement after 24 th  week Consider aspiration prophylaxis; midazolam (reduce  maternal stress ->improve fetal blood flow) Consider Fetal monitoring (but no good data) Consult with obstetrician
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ANESTHETIC CHOICES GA-preoxygenate, rapid sequence induction,  slow reversal of relaxants, +/- N2O Loss of beat to beat FHR variability is normal; Fetal bradycardia is not! Regional anesthesia-minimal effects on fetus  (assuming normal BP) Cut neuraxial dose of local anesthetic by 1/3 rd   compared to non-pregnant patient NO evidence showing better outcome
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POST - OP Continue fetal monitoring Because of risk of thromboembolism: Early mobilization Consider anticoagulants Post op analgesia (regional is good at this)
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    LABOR ANALGESIA Intravenous Neuraxial: Epidural Spinal Combined Spinal-Epidural
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Goals of Labor Analgesia Adequate Analgesia Allow the mother to participate in birthing  experience Minimal effect on the fetus Minimal effect on the progress of labor 
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Neuraxial Blockade A well conducted block provides the most 
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This note was uploaded on 12/28/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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ObstetricalAnesthesia - AnesthesiafortheObstetrical Patient...

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