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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Aug 28, 2016 | Posted by in ANESTHESIA | Comments Off on FOR OBSTETRIC AND GYNECOLOGIC SURGERY

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