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Obstetric anesthesia in Estonia (Tartu)

Obstetric anesthesia in Estonia (Tartu). Juri Karjagin with the help from Raido Paasma (Pärnu) Jaanus Eelermaa (Tallinn) Neeme Somma (Tallinn). Some geo-demographic data. Area 45 227 km 2 Inhabitants 1 340 194 (01.01.2011). Births 2007 - 2010. www.stat.ee. Analgesia in labour.

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Obstetric anesthesia in Estonia (Tartu)

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  1. Obstetric anesthesia in Estonia (Tartu) Juri Karjaginwiththehelpfrom RaidoPaasma (Pärnu) Jaanus Eelermaa (Tallinn) Neeme Somma (Tallinn)

  2. Some geo-demographic data • Area 45 227 km2 • Inhabitants 1 340 194 (01.01.2011)

  3. Births 2007 - 2010 www.stat.ee

  4. Analgesia in labour • Midwifesand/orobstetrician • Systemicdrugs • Paracetamol • Opioids • N2O • Blocks • Paracervicalblocks (Tartu data) • 2008 16.6% of all labours • 2009 and 2010 7-8% • Aquablocks ???

  5. Analgesia in labour • Anesthesiologists • Epidural • Spinal • Combined spinal-epidural

  6. Epidural in labour

  7. Some hospitals…

  8. Epidural: drugs and methods • Bupivacaine 0.1 – 0.125% • Fentanyl 5 – 10 µg/ml • Placement in labour room • Standart monitoring • Blood pressure • Pulse-oximetry • First dose (5 ml) by anesthetist >>midwife as required

  9. Other regional • Mini-spinal 2ml • Bupivacaine 2.5 mg + Fentanyl 25µg + NaCl 0.9% • Numbers are 10-20 for whole Estonia, but it seems gaining popularity • Combined technique ???

  10. Cesarean section

  11. Cesarean section

  12. Cesarean section Tartu data 2010 • 537 CS (20,7% of all labours) • 204 elective and 333 emergency • Elective • 77% regional (100% spinal) • 23% general • Emergency • 44.7% regional (12% epidural and 88% spinal) • 55.35 general

  13. Spinal for CS • Bupivacaine heavy or plain (7-10 mg) with or without fentanyl (10-20 µg) • Vasopressors tactics (Tartu) • phenylephrine 0.1 mg/ml 30 ml/t simultaneously with injection • Ephedrine 0.5 mg/ml by drip or 5 mg boluses • Conversion to general ca 2.5% in Tartu (2010)

  14. Epidural top-up for CS • In operating theatre • Drugs • Marcaine 0.5% 75 mg • Lidocaine 2% 200-300 mg

  15. Problems… • Airways • PDPH

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