Intrapartum Care (Anaesthetics)

Question 1

Describe the principles of intrapartum analgesia:
• Non-pharmacological
• Pharmacological
»»Nitrous
»»Narcotic
»»Regional

Answer 1

Non-Pharmacological:

• support person, antenatal classes/education
• heat packs, water baths
• acupuncture, hypnosis
• TENS

Pharmacological:

• NO: gas, fast acting, limited efficacy
• Narcotics: Fentanyl (PCA), Pethidine (N/V, dysphoria)

Regional

• Spinal
• Epidural
• CSE

Question 2

Describe the principles of anaesthesia for operative birth
• Regional anaesthesia
• General anaesthesia

Answer 2

Regional
> SPINAL: injected into epidural space, (+) quick onset/ quick acting, dense block/very effective; (-) can’t be topped up, only lasts 1-2hrs, may cause profound hypotension

> EPIDURAL: usually bupivicaine (LA) + fentanyl (opioid), into epidural space, (+) slow onset/long acting, minimal adverse effect fetus, can be topped up; (-) reduces maternal urge push, reduces response PPH, may cause hypotension & resp depression

General:

• rarely used, only if CI spinal/epidural e.g. idiopathic intercranial HT
• complications: increased difficulty intubation (laryngeal oedema), aspiration risk, higher risk hypoxia (due to decreased FRC)