Obstetric Anesthesia ASA Guidelines Flashcards
Perianesthetic Evaluation and Preparation: which fHistory
° focused history
- maternal health 2. anesthetic history,
- a relevant obstetric history,
Perianesthetic evaluation and Preparation : focused physical exam
- baseline blood pressure measurement
- an airway, heart, and lung examination, consistent with the American Society of Anesthesiologists (ASA)
- When a neuraxial anesthetic is planned or placed, examine the patient’s back.
Aim of preoperative assessment
Recognition of significant anesthetic or obstetric risk factors should encourage consultation between the obstetrician and the anesthesiologist.
What is the recommendations on intrapartum Platelet Count?
- A routine platelet count is not necessary in the healthy parturient
- decision to order or
require a platelet count should be individualized and based
on a patient’s history (e.g., preeclampsia with severe features),
physical examination, and clinical signs.
Blood Type and Screen
routine blood cross-match is not necessary for healthy and uncomplicated parturients for vaginal or operative delivery.
The decision whether to order or require a blood type and screen or cross-match should be based on maternal history, anticipated hemorrhagic complications (e.g., placenta accreta in a patient with placenta previa and previous uterine surgery), and local institutional policies.
Perianesthetic Recording of Fetal Heart Rate Patterns
Fetal heart rate patterns should be monitored by a qualif ied individual before and after administration of neuraxial analgesia for labor.
Continuous electronic recording of fetal heart rate patterns may not be necessary in every clinical setting and may not be possible during placement of a neuraxial catheter.**
Aspiration Prevention Clear Liquids during labour and for c/s
The oral intake of moderate amounts of clear liquids may be allowed for uncomplicated laboring patients moderate amounts of
clear liquids up to 2h before induction of anesthesia.
• The uncomplicated patient undergoing elective surgery may have clear liquids up to 2 h before induction of anesthesia.
º Examples of clear liquids include, but are not limited to, water, fruit juices without pulp, carbonated beverages, clear tea, black coffee, and sports drinks.
º The volume of liquid ingested is less important than the presence of particulate matter in the liquid ingested.
• Laboring patients with additional risk factors for aspiration (e.g., morbid obesity, diabetes mellitus, and diff icult airway) or patients at increased risk for operative delivery (e.g., nonreassuring fetal heart rate pattern) may have further restrictions of oral intake, determined on a case-by-case basis.
Recommendations on aspiration prevention with regards to solids?
Solid foods should be avoided in laboring patients.
laboring patients with additional risk factors
for aspiration (e.g., morbid obesity, diabetes mellitus, and
difficult airway) or patients at increased risk for operative
delivery (e.g., nonreassuring fetal heart rate pattern) may
have further restrictions of oral intake, determined on a
case-by-case basis;
• The patient undergoing elective surgery (e.g., scheduled
cesarean delivery or postpartum tubal ligation) should
undergo a fasting period for solids of 6 to 8 h depending
on the type of food ingested (e.g., fat content).###
Antacids, H2-receptor Antagonists, and Metoclopramide
Before surgical procedures (e.g., cesarean delivery and
postpartum tubal ligation), consider the timely admin-
istration of nonparticulate antacids, H2-receptor antago-
nists, and/or metoclopramide for aspiration prophylaxis.
Recommandation on Anesthetic Care for Labor and Vaginal Delivery timing of neuraxialblock ?
• Provide patients in early labor (i.e., less than 5 cm dila-
tion) the option of neuraxial analgesia when this service
is available.
• Offer neuraxial analgesia on an individualized basis
regardless of cervical dilation.
º Reassure patients that the use of neuraxial analgesia
does not increase the incidence of cesarean delivery.
Recommendations on neuraxial block for VBAC?
Offer neuraxial techniques to patients attempting vaginal
birth after previous cesarean delivery
these patients, it is appropriate to consider early
placement of a neuraxial catheter that can be used later for
labor anal
Recommendations on when early insertion of neurexial catheter?
Consider early insertion of a neuraxial catheter for obstet-
ric (e.g., twin gestation or preeclampsia) or anesthetic
indications (e.g., anticipated difficult airway or obesity)
to reduce the need for general anesthesia if an emergent
procedure becomes necessary.
º In these cases, the insertion of a neuraxial catheter may
precede the onset of labor or a patient’s request for
labor analgesia.
Recommendations on CIE?
Continuous epidural infusion may be used for effective
analgesia for labor and delivery.
• When a continuous epidural infusion of local anesthetic is
selected, an opioid may be added to reduce the concentra-
tion of local anesthetic, improve the quality of analgesia,
and minimize motor block.
Recommandation on analgesic concentrations?
Use dilute concentrations of local anesthetics with opioids
to produce as little motor block as possible
Recommendations on single spinal opioids with/without local anaesthetic?
Single-injection spinal opioids with or without local anes-
thetics may be used to provide effective, although time-
limited, analgesia for labor when spontaneous vaginal
delivery is anticipated.
• If labor duration is anticipated to be longer than the anal-
gesic effects of the spinal drugs chosen, or if there is a rea-
sonable possibility of operative delivery, then consider a
catheter technique instead of a single-injection technique.
• A local anesthetic may be added to a spinal opioid to
increase duration and improve quality of analgesia.
Resources for management o f hemorrhagic emergencies
Institutions providing obstetric care should have resources available to manage hemorrhagic emergencies (table 1).
º In an emergency, type-specific or O-negative blood is acceptable.
º In cases of intractable hemorrhage, when banked blood is not available or the patient refuses banked blood,
consider intraoperative cell salvage if available.†††
Equipment for Management of Airway Emergencies.
Labor and delivery units should have personnel and equipment readily available to manage airway emergencies consistent with the ASA Practice Guidelines for Management of the Difficult Airway,‡‡‡ to include a pulse oximeter and carbon dioxide detector.
º Basic airway management equipment should be im-
mediately available during the provision of neuraxial
analgesia (table 2).
º Portable equipment for difficult airway management should be readily available in the operative area of labor and delivery units (table 3).
º A preformulated strategy for intubation of the difficult
airway should be in place.
º When tracheal intubation has failed, consider venti-
lation with mask and cricoid pressure or with a su-
praglottic airway device (e.g., laryngeal mask airway,
intubating laryngeal mask airway, and laryngeal tube)
for maintaining an airway and ventilating the lungs.
º If it is not possible to ventilate or awaken the patient,
a surgical airway should be performed.
