Obstetric Anaesthesia

Question 1

What are the main pharmacological ways of managing pain in labour?

Answer 1

1) Paracetamol/Codeine/Opioids (Pain Ladder)
2) Entonox (Gas and Air)
3) Epidural
4) Spinal anaesthesia

Question 2

What are the main non-pharmacological ways of managing pain in labour?

Answer 2

Trained support.
Acupuncture.
Hypnotherapy.
Massage.
Hydrotherapy.

Question 3

What is the main difference between spinal and epidural?

Answer 3

Epidural: Into Epidural space
Spinal: Into CSF in SC below Filum Terminale

Question 4

What is an example of an epidural and how does it work?

Answer 4

Bupivacaine: Blocks Na Channels

Question 5

Give 3 potential side effects of opioids.

Answer 5

Sedation.
Respiratory depression.
N&V.
They cross the placenta readily.

Question 6

What are the indications for an epidural?

Answer 6

1) Twins
2) Augmented labour
3) maternal request
4) Existing co-morbidities

Question 7

What are the contra-indications for an epidural?

Answer 7

1) Allergy
2) Maternal refusal
3) Local infection

Question 8

Why would a general anaesthetic be given for performing a c-section?

Answer 8

If there is a threat to the mum/foetus and so a regional anaesthetic is contraindicated.

Question 9

Give 2 disadvantages of using a general anaesthetic for a c-section.

Answer 9

1) As IV, baby also anaesthetised
2) Risk of aspiration

Question 10

What are advs/disadvs of local for a c-section?

Answer 10

Adv: Safer, baby immediately, partner present
DisAdv: Hypotension, headaches and discomfort from pressure sensations