Local Anesthetics and Toxicity
B. Local anesthetics with an ester bond linking the aromatic ring to the hydrocarbon chain are classified as amino-ester local anesthetics. These include procaine, 2-chloroprocaine, tetracaine, and cocaine (see Table…
Uteroplacental Anatomy, Blood Flow, Respiratory Gas Exchange, Drug Transfer, and Teratogenicity
A. Anatomic and physiologic changes. Maternal anatomic and physiologic changes occur during pregnancy to ensure enough blood flow is delivered to the uterus. Uterine blood flow occurs through two routes. 1. …
Postcesarean Analgesia
g. The demand-only IV PCA incorporates several safety features to minimize the possibility of a patient receiving unsafe doses of IV opioid. First, the PCA pump is programmed to limit the…
Obstetric Medications
4. Route of administration/dose a. Terbutaline can be administered intravenously (IV) or subcutaneously (SC). However, it is most commonly administered by intermittent injection in doses of 0.25 mg every 20 to 30…
Management of Postdural Puncture Headache
I. Scope of the problem II. Pathophysiology A. Meningeal traction B. Cerebral vasodilation III. Risk factors for postdural puncture headache A. Unmodifiable risk factors B. Modifiable risk factors IV. Diagnosis…
Impact of Neuraxial Analgesia on Obstetric Outcomes
CLINICAL PEARLNeuraxial analgesia provides superior pain relief to the mother during labor and delivery and conveys other significant benefits. II.Effects of neuraxial analgesia on the progress of labor A. Observational…
Trauma in the Obstetric Patient
CLINICAL PEARL A severely injured unstable pregnant trauma patient should be treated similarly to any other unstable trauma patient. 1. Pregnancy workup. Maternal pelvic examination should include abdominal palpation of the…
Nonobstetric Surgery during Pregnancy
An association between benzodiazepine use and oral cleft anomalies was reported in the 1970s, but later case-control and prospective studies failed to demonstrate a relationship between oral cleft anomalies and…
Ethical and Legal Considerations in Obstetric Anesthesia
Ethical and Legal Considerations in Obstetric Anesthesia M. Joanne Douglas and William J. Sullivan I. Introduction to ethics II. Informed consent A. Background B. Can laboring women give informed…
