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Obstetric Anesthesia

Obstetric Anesthesia. Jocelyn Wertz T4 3/22/12. the history of ob anesthesia. First used in 1847 Ether and chloroform Originally linked with increased rate of puerperal fever Less pain  more interventions Effect on fetus & labor denied for many years. Modern Ob Anesthesia.

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Obstetric Anesthesia

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  1. Obstetric Anesthesia Jocelyn Wertz T4 3/22/12

  2. the history of ob anesthesia • First used in 1847 • Ether and chloroform • Originally linked with increased rate of puerperal fever • Less pain  more interventions • Effect on fetus & labor denied for many years

  3. Modern Ob Anesthesia • Regional anesthesia • Spinal • Epidural • Combined Spinal-Epidural • General anesthesia • Reserved for rare cases of contraindication to/failed regional anesthesia • Non-pharmacologic • Breathing techniques • Doulas • Water bath • Local anesthesia • Bilateral pudendal nerve block • Systemic medications • Opioids • Sedatives

  4. Spinal technique • Follow sterile technique • Position patient • Traverse: skin, subQ tissue, supraspinous ligament, interspinous ligament, ligamentumflavum, epidural space and dura • Administer meds

  5. Epidural technique • Follow sterile technique • Position patient • Traverse: skin, subQ tissue, supraspinous ligament, interspinous ligament and ENTER ligamentumflavum • Use loss of resistance technique to enter epidural space without dura puncture • Insert catheter • Administer test dose • Monitor • Administer medication

  6. Key differences • Epidural • Epidural space • More volume (10-20mL) • Catheter placed • Onset typically in 15-30 minutes • Causes neuromuscular block only when specific local anesthetics are used • Spinal • Subarachnoid space • Small volume (1.5-3.5mL) • Single shot • Onset typically in 5 minutes • Often causes significant neuromuscular block

  7. Combined spinal epidural technique • Combines the certainty of a spinal (appearance of CSF) with the flexibility of an epidural (continuous analgesia) • No unique complications

  8. Vaginal versus cesarean • Motor block is desired for C-section but not for vaginal • Vaginal should have analgesia to the T10 dermatome, C-section to T4 • C-section needs stronger analgesia to block pain of surgery

  9. What should I use? • Spinal • Preferred option for simple Cesarean Sections • Increased risk of hypotension requiring treatment • Epidural • A good option for women in whom spinal analgesia is contraindicated • CSE • Preferred option for laboring women who need pain relief NOW and for the forseeable future • Preferred option for Cesareans expected to last >90 minutes • Growing in popularity and now used for women in all stages of labor

  10. references 1. Grant G and Hepner D. Anesthesia for Cesarean Delivery. Up To Date. March 6, 2012. 2. Ng K, Parsons J, Cyna AM, Middleton P. Spinal versus epidural anaesthesia for caesarean section (Review). 2007 The Cochrane Collaboration. 3. Eisenach JC. Combined Spinal-Epidural Analgesia in Obstetrics. Anesthesiology. 1999; 91:299-302. 4. Bali A, Sharma J, Gupta SD. Combined Spinal Epidural Anaesthesia. JK Science. 2007; (9)4:161-163. 5. Nageotte MP et al. Epidural Analgesia Compared With Combined Spinal-Epidural Analgesia During Labor in Nulliparous Women. NEJM. 1997; (337)24:1715-1720. 6. Wong C, Nathan N, Brown D. Obstetric Analgesia: Chapter 12 Spinal, Epidural, and Caudal Anesthesia: Anatomy, Physiology, and Technique. 4th edition 1999; p223-249.

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