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OBSTETRICAL ANESTHESIA

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Local Perineal Anesthesia

  1. local blocks
  2. lidocaine for episiotomy
  3. pudendal blocks
Regional Anesthesia

Epidural

  1. most commonly used technique for both labour and delivery
  2. does not prolong first stage, but may reduce maternal expulsive efforts
  3. 0.25% bupivacaine (Marcaine) usually used for labour (longer acting compared to lidocaine and less motor block)
  4. 2% lidocaine (Xylocaine) usually used for vaginal deliveries and C-section in varying doses
  5. 19 gauge indwelling catheter inserted into lumbar epidural space
  6. preload mother with 500-1000 mL IV fluid to prevent maternal hypotension associated with epidural (fetal depression rare if maternal hypotension avoided)
  7. test dose given first to check for spinal block followed by another dose to rule out intravascular injection - if nodizziness or tinnitus, rest of dose is given
  8. complications: inadvertent total spinal with cardiovascular collapse and respiratory arrest, intravascular injection with seizures, post-ictal depression and possible cardiac arrest
Walking epidural
  1. goal is effective analgesia with no motor blockade
  2. 0.125% bupivacaine plus low dose fentanyl

Spinal block
  1. for C-section need anesthesia of T4-T8
  2. injection of local anesthetic into subarachnoid space
  3. fastest onset
  4. least drug exposure for fetus because small dose required
  5. not appropriate for labour due to intense motor blockade
  6. beware of rapid hypotension and preload mother with 1000 mL IV fluid
General Anesthesia
 
  1. not used for vaginal deliveries 
  2. rapid sequence induction to prevent aspiration 
  3. pre-oxygenate mother with 100% O2as she is prone to hypoxia during intubation secondary to decreased FRC and increased O2 consumption
OBSTETRICAL ANESTHESIA OBSTETRICAL ANESTHESIA Reviewed by Radiology Madeeasy on January 17, 2011 Rating: 5
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