Obstetric Anaesthesia

Question 1

What are the roles of the anaesthetist in obstetric care?

Answer 1

Pain relief for labour
Anaesthesia for instrumental/operative delivery
Input on Obstetric High Dependency Unit
Anaesthetic antenatal clinic

Question 2

Which nerve roots are involved in labour pain?

Answer 2

T10 – L1

S2 – S4

Question 3

What are the non-pharmacological therpaies for pain relief in labour?

Answer 3

hypnobirthing 
acupuncture 
massage 
TENS - trnascutaneous electric nerve stimulation 
hydrotherapy

Question 4

what are the pharmacological methods for pain relief?

Answer 4

Entonox
Oral analgesia
‘Single shot’ parenteral opioids
PCA opioids
Regional techniques - epidural, spinal, combined spinal and epidural

Question 5

what are the adv and disadv of using etonox?

Answer 5

Adv

• rapid onset of analgesia
• minimal side effects

Disadv
- bone marrow suppression

Question 6

what oral anaesthesia may women use?

Answer 6

paracetamol

codeine

Question 7

How are opioids adminsitered in labour and what type are used?

Answer 7

single shot - IM: morphine, diamorphine, pethidine

PCA via IV cannula: remifentanyl, fentanyl, alfentanil

Question 8

what are the main side effects of opioids?

Answer 8

sedation, respiratory depression, N&V, pruritus
baby can be delivered sedated if used too close to delivery
obesity - more likely to get resp depression

Question 9

At what level is an epidural inserted?

Answer 9

L3/4

Question 10

At what level does the spinal cord terminate in adults?

Answer 10

L2

Question 11

what landmark is used to indicate L3/4?

Answer 11

Tuffier’s line - between the ileac crests

Question 12

What layers would an epidural go through?

Answer 12

Skin
Spinous ligament
Ligamentum flavum
Epidural space

(a spinal needle would also go through the dural sac)

Question 13

where would you put a spinal needle?

Answer 13

below L2/3

Question 14

What are the indications for an epidural?

Answer 14

gestational hypertension, PET
Multiple births
instrumental/operative delivery likely
Cardiac/other medical disease
Augmented labour eg with syntocinon
maternal request

Question 15

what are the absolute and relative CIs for an epidural?

Answer 15

Absolute

• Maternal refusal
• Local infection
• Allergy to local anaesthetic

Relative

• Coagulopathy
• Systemic infection
• Hypovolaemia
• Abnormal anatomy
• Fixed cardiac output eg aortic stenosis

Question 16

what are the adverse effects of an epidural or spinal?

Answer 16

Cardiovascular - hypotension 
Respiratory - resp depression
Neurological - permanent nerve damage 
Drug related
Post-dural puncture headache 

May prolong labour
May increase instrumental delivery
Maternal pyrexia

Question 17

What pain relief is used for operative delivery?

Answer 17

General Anaesthesia
Epidural top up - high conceptration epidural and opioid
Spinal - bupivacaine plus opioid
CSE

Question 18

when is GA used for c-section?

Answer 18

Imminent threat to mother and/or foetus
Contraindication to regional
Maternal preference
Failed regional technique

Question 19

What are the risks of GA?

Answer 19

Aspiration
Failed intubation
Awareness

Question 20

what are the advantages of regional anaesthesia

Answer 20

Safer
Can see baby immediately
Partner present
Improved post op analgesia

Question 21

what are the disadvantages of regional anaesthesia

Answer 21

Hypotension
Headache
Discomfort associated with pressure sensations
Failure

Question 22

How does a post-dural headache present?

Answer 22

postural headache - better when lying down 
occipitofrontal 
neck stiffness
photophobia
make sure no rash