Analgesia and anesthesia for obstretic cases Flashcards
What is the method to improve blood flow in pregnancy?
Avoid aortocaval compression
Bilateral hands manual displacement is recommended by ACLS
What is indicated in pregnancy for GA?
Intubation is required for GA
Reduced gastric emptying (hormonal, cephalad stomach)
Increase gastric secretion and aciditiy
What is the origin of labor pain in 1st and 2nd stage?
1st stage
* Visceral C and A-delta
* Lower segment and cervix –> paracervical ganglion –> lumbar sympathetic chain –> T10-L1 DRG +contralateral -> supraspinal
2nd stage
* Larger Adelta fibers
* Vagina, perineum
* Pudendal nerve
* Somatic DRG S2-4
What are commonly used anasthetic regimens in QMH?
- Spinal anesthesia for CS: 0.5% heavy bupivacaine + preservative free fentanyl + preservative free morphien
- Epidural analgesia for CS: 0.5% bupivaaine or 1% ropivavaine or 2% lignocaine with 1:200,000 adrenaline
- Epidural analgesia for labor pain relief: initiation boluses: 0.3% ropivacaine. Maintenance 0.15% ropivaaine + preservative free fentanyl in PCFA (patient controlled analgesia mode)
Absolute and relative contraindications to regional anesthesia/analgesia?
Absolute contraindications
* Coagulopathy
* Systemic septicemia
* Hypovolemia
* Raised ICP
* Patients refusal
Relative contraindications
* Difficult anatomy
* Pre-existing neurological deficits
What is done for airway assessment?
- Thyromental distance
- Receeding chin
- Incisor gap
- Dentition
- Head and neck movement
- Obesity
- Congential craniofacial abnormalities
- Mallampati classification
What is the Mallampati classification?
Left: Syringe driver
Right: Intraoperative cell salvage (collect and process RBC blood loss from surgery and transfuse them to patients circulation during or immediately after surgery)
