Obstetric Anesthesia
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Transcript 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
Non-pharmacologic
Breathing techniques
Doulas
Water bath
Local anesthesia
Bilateral pudendal nerve
block
Systemic medications
Opioids
Sedatives
Regional anesthesia
Spinal
Epidural
Combined SpinalEpidural
General anesthesia
Reserved for rare cases
of contraindication
to/failed regional
anesthesia
SPINAL TECHNIQUE
Follow sterile
technique
Position patient
Traverse: skin, subQ
tissue, supraspinous
ligament, interspinous
ligament, ligamentum
flavum, epidural
space and dura
Administer meds
EPIDURAL TECHNIQUE
Follow sterile technique
Position patient
Traverse: skin, subQ tissue,
supraspinous ligament,
interspinous ligament and
ENTER ligamentum flavum
Use loss of resistance
technique to enter epidural
space without dura
puncture
Insert catheter
Administer test dose
Monitor
Administer medication
KEY DIFFERENCES
Spinal
Subarachnoid space
Small volume (1.53.5mL)
Single shot
Onset typically in 5
minutes
Often causes
significant
neuromuscular block
Epidural
Epidural space
More volume (1020mL)
Catheter placed
Onset typically in 1530 minutes
Causes neuromuscular
block only when
specific local
anesthetics are used
COMBINED SPINAL EPIDURAL TECHNIQUE
Combines the
certainty of a spinal
(appearance of CSF)
with the flexibility of
an epidural
(continuous
analgesia)
No unique
complications
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
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
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. 4 th edition 1999; p223-249.