OGCO-C3.1 Analgesia and Anaesthetics for Obstretic patients

Question 1

What are non pharmacological pain relief?

Answer 1

• Aromatherapy
• Breathing techniques and relaxation
• Movement and positioning including birth balls (non painful pressure applied to the perineum which may reduce sensation of labor pain)
• Music and audio-analgesia
• TENS (transcutaneous electricael nerve stimulation): contraindications include cardiac pacemakers, bleeding disorders and epilepsy
• Massage and touch

Question 2

What are analgesics methods including epidural analgesia?
What are there associated complications?

Answer 2

• Self administration of Entonox (50% oxygen:50% nitrous oxide) via facemask
• Pethidine IM 50-75mg can be given if labor definitely in progress. This can be repeated 3-4 hourly if nevessary. Can cause maternal and respiratory depression. Nasal cannula may be required to give O2 to patient.
• Epidural analgesia. Complications (hypotension, accidental dural puncture, high block, anaphylaxis). While on epidural all patients must be nursed in the lateral or wedged position to avoid aortocaval compression. Should be monitored with clinical symptoms, BP, FHR and if necessary ECG and pulse oximetry.
• Anesthesia for C section: general or regional anesthesia. Regional anesthesia includes epidural and spinal anaesthesia and combined technique.

Question 3

What past history and present pregnancy info is assessed in anaes consultation clinic?

Answer 3

Question 4

What is the aspiration prophylaxis for elective Caesarean section in morning or afternoon?

Answer 4

Question 5

What is the aspiration prophylaxis for emergency Caesarean section?

Answer 5

a) Pantoprazole 40mg IVI (24hourly if repeated dose needed) when the decision of emergency LSCS/operation is made. (Omit if the patient is already taking oral Famotidine).
b) 0.3M sodium citrate 30ml upon entry into the operating theatre.
c) Keep patient nil by mouth

Question 6

What is the aspiration prophylaxis for conditions with anticipated increased risk of emergency opertaion or patients with features of difficult airway and women with contraindication for regional anesthesia (on anticoagulants, bleeding patients)?

Answer 6