FOR OBSTETRIC AND GYNECOLOGIC SURGERY

ANESTHESIA FOR LABOR AND DELIVERY

•  Nonpharmacologic analgesia choices: Hypnotherapy, hydrotherapy, and transcutaneous electrical nerve stimulation (TENS)

•  Pharmacologic analgesia: Inhalation analgesia, parenteral opioid analgesia (fentanyl, nalbuphine), pudendal block, paracervical block, neuraxial analgesia. Of these, epidural & combined spinal-epidural (CSE) analgesia are most effective

POSTDURAL PUNCTURE HEADACHE (PDPH)

Differential dx: Nonspecific headache, migraines, lactation headaches, cortical vein thrombosis, meningitis, subdural hematoma, subarachnoid hemorrhage

H&P and +/- neuroimaging necessary for correct diagnosis

DRUGS USED IN OBSTETRIC SURGERY

INTRAPARTUM FETAL ASSESSMENT AND THERAPY

UTEROPLACENTAL BLOOD FLOW

Factors That Decrease Uterine Blood Flow

PLACENTAL TRANSFER OF MEDICATIONS

Inhalational & IV induction agents, local anesthetics → can cross placenta

• However, bupivacaine highly protein-bound & chloroprocaine highly metabolized (fetal conc. of these drugs lower than when lidocaine is used)

APGAR SCORE

ANTEPARTUM HEMORRAGE

POSTPARTUM HEMORRHAGE

•  Incidence: 10% of all deliveries

•  Definition: 500 mL EBL in vaginal delivery, 1,000 mL EBL for CS

•  Anesthetic management:

→ Assess pt volume status, hemoglobin & coagulation status, IV access

→ Send T&S or type & crossmatch for blood

→ Administer IV fluid, blood, & vasopressors as indicated

HYPERTENSIVE DISORDERS OF PREGNANCY

Preeclampsia

•  Definition: Hypertension + proteinuria after 20 wks’ gestation

•  Pathophysiology: Exact mechanism unknown, may involve imbalance between prostaglandins (thromboxane A & prostacyclin), abnl sensitivity to catecholamines, or antigen–antibody reactions between fetal & maternal tissues

•  Treatment: Only definitive cure for preeclampsia is delivery of the infant

ANESTHESIA FOR GYNECOLOGIC SURGERY

Postpartum Tubal Ligation (PPTL)

•  Benefits of immediate PPTL include

• Ease of access to fallopian tubes (uterus & ovaries are out of pelvis)

• ↓ risk of bowel laceration, vascular injury

• ↓ duration of hospital stay, ↓ cost (compared to outpatient procedure)

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Jul 4, 2016 | Posted by in ANESTHESIA | Comments Off on FOR OBSTETRIC AND GYNECOLOGIC SURGERY

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