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PRF. TARIK Y. ZAMZAMIMD, CABOG, fICS PROFESSOR & OB/GYNCONSULTANTKAUHSCHOOL OF MEDICINE [email protected]
Analgesia & Anesthesia in ObstetricsPain relief in labor:is it important !
Advantages:Child birthPain-Fear-Anxiety Syndrome
Surgical VS Obstetrics PatientsPatientUterine contractionsDurationPreparation
What Are The Criteria? Fetal homeostasisSimplicitySafety
I- Obstetric AnalgesiaNarcotic injectionInhalation
II- Obstetric Analgesia&AnesthesiaRegional Anesthesia: . Epidural . Spinal . Local General Anesthesia
Narcotic AnalgesiaPethidineDose 50 - 100 mgRoute I/MFrequency 3 - 4 hoursPromethazine 25 mg I/M
Side EffectMother: .Euphoria .Nausea&Vomiting .DizzinessFetus: .Respiratory depression
Narcotic AntagonistNaloxon hydrochloride (Narcan)ActionDose 10 g/kg
Inhalation AnalgesiaAnesthetic agent: .Entonoxe .Nitrous oxide .50:50 %
Epidural ExcellentPortal entry: L3 - L4Labor&vaginal delivery: Block T10 - S5Cesarean section: Block T8 - S1A.Agent: MarcainDuration: 1 - 3 hours
IndicationsMaternal requestMalpresentationMultiple pregnancyPreterm laborCardiac disease
ContraindicationsPatient refusedLocal sepsisAnti-coagulant therapyObstructive cardiomyopathyBleedingInadequate staffPrevious surgery
ComplicationsHypotensionBladder dysfunctionDural tapIncomplete analgesia
Spinal AnalgesiaPort entry: L3 - L4Space: subarachnoid Level of blockade: T10 - T6
IndicationsManual removal of placentaCesarean section
ComplicationsTotal spinal blockadeSpinal headache HypotensionBladder dysfunction
Local AnesthesiaPudendal blockLocal infiltration
Pudendal BlockTechniqueIndicationDisadvantages
Local InfiltrationTechniqueIndication
General AnesthesiaIs one of the leading cause of maternal death in obstetrics
ComplicationsRespiratory depression of new bornPostpartum hemorrhageGastric aspiration
Mendelson Syndrome
Effect of Pregnancy on StomachDelay gastric emptyingRelaxation of gastro-esophageal sphincterRaised intragastric press
Clinical Features of Aspiration PneumoniaTachypneaBronchospasmHypotensionCyanosisAtelectasis
Prevention of Mendelson SyndromeWell trained AnesthetistNPO for 12 hoursEating&drinking are prohibited during laborAntacid