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ANAESTHESIA & ANALGESIA IN OBSTETRICS & GYNAE

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  • 1. ANAESTHESIA & ANALGESIA INANAESTHESIA & ANALGESIA IN OBSTETRICS & GYNAECOLOGYOBSTETRICS & GYNAECOLOGY www.doctor.sdwww.doctor.sd
  • 2. INTRODUCTIONINTRODUCTION  ENDEAVOURS TO ALLEVIATE PAIN OF LABOUR DATES FARENDEAVOURS TO ALLEVIATE PAIN OF LABOUR DATES FAR BACK;BACK;  -EARLY CHINESE : USED OPIATES-EARLY CHINESE : USED OPIATES  -MIDDLE AGES : SELFADMINISTRATION OF ALCOHOLICS-MIDDLE AGES : SELFADMINISTRATION OF ALCOHOLICS  -ETHER ; THE FIRST OBSTETRIC ANAESTHETIC, INTRODUSED-ETHER ; THE FIRST OBSTETRIC ANAESTHETIC, INTRODUSED BY DR.J Y SIMPSON IN 1847BY DR.J Y SIMPSON IN 1847  -CHLOROFORM ; IN 1853, WAS USED BY JOHN SNOW TO-CHLOROFORM ; IN 1853, WAS USED BY JOHN SNOW TO DELIVER QUEEN VICTORIA IN THE BIRTH OF PRINCEDELIVER QUEEN VICTORIA IN THE BIRTH OF PRINCE LEOPOLDLEOPOLD  -NITROUS OXIDE ; WAS FIRST USED BY KLIKOWITSH IN 1881-NITROUS OXIDE ; WAS FIRST USED BY KLIKOWITSH IN 1881  -SYSTEMIC ANALGESICS;IN 1902 COMBINATION OF-SYSTEMIC ANALGESICS;IN 1902 COMBINATION OF MORPHINE & SCOPOLAMINE AND SINCE 1940 TILL TODAYMORPHINE & SCOPOLAMINE AND SINCE 1940 TILL TODAY PETHIDINE IS USEDPETHIDINE IS USED  -LOCAL ANAESTHETICS ; IN 1910 COCAINE WAS APPLED TO-LOCAL ANAESTHETICS ; IN 1910 COCAINE WAS APPLED TO VAGINA AND VULVAVAGINA AND VULVA  -SPINAL & EPIDURAL; WERE KNOWN SINCE 1928 AND 1940-SPINAL & EPIDURAL; WERE KNOWN SINCE 1928 AND 1940 www.doctor.sdwww.doctor.sd
  • 3. THE AIMS OF OBSTETRICTHE AIMS OF OBSTETRIC ANALGESIA AREANALGESIA ARE  (1) TO RELIEVE PAIN AND(1) TO RELIEVE PAIN AND DISCOMFORT,DISCOMFORT,  (2) WITHOUT PROLONGING LABOUR,(2) WITHOUT PROLONGING LABOUR,  (3) WITHOUT SIGNIFICANT HAZARD TO(3) WITHOUT SIGNIFICANT HAZARD TO THE MOTHER,THE MOTHER,  (4) WITHOUT SIGNIFICANT HAZARD TO(4) WITHOUT SIGNIFICANT HAZARD TO THE BABY.THE BABY. www.doctor.sdwww.doctor.sd
  • 4. METHODS:METHODS:  A] NON-PHARMACOLOGICALA] NON-PHARMACOLOGICAL::  [1][1] PSYCHOPHYSICALPSYCHOPHYSICAL -- ANTENATAL PREPARATION-- ANTENATAL PREPARATION  - EDUCATION- EDUCATION  - DEVELOPMENT OF VARIOUS TECHNIQUES OF- DEVELOPMENT OF VARIOUS TECHNIQUES OF RELAXATIONRELAXATION  [2][2] HYPNOSISHYPNOSIS -- LIMITTED SUCCESS RATE( 25-60%) AND REQUIRE A-- LIMITTED SUCCESS RATE( 25-60%) AND REQUIRE A GREAT DEAL OF TIME TO FULLFIL.GREAT DEAL OF TIME TO FULLFIL.  [3][3] ACUPUNCTUREACUPUNCTURE -- LIMITTED EFFICACY FOR THE PAIN OF LABOUR-- LIMITTED EFFICACY FOR THE PAIN OF LABOUR  [4][4] TRANSCUTANEOUS NERVE STIMULATION ( TNS )TRANSCUTANEOUS NERVE STIMULATION ( TNS ) -- APPLICATION-- APPLICATION OF A VARIABLE ELECTRICAL STIMULUS TO THE SKINOF A VARIABLE ELECTRICAL STIMULUS TO THE SKIN  IT IS MOST HELPFUL FOR BACHACHE. ITS SUCCESS IN LABOUR ISIT IS MOST HELPFUL FOR BACHACHE. ITS SUCCESS IN LABOUR IS 20 - 60%20 - 60%  [5[5]] AUDIOANALGESIAAUDIOANALGESIA -- THE USE OF WHITE SOUND, MAY HELP !-- THE USE OF WHITE SOUND, MAY HELP !  [6][6] ABDOMINAL DECOMPRESSIONABDOMINAL DECOMPRESSION -- HAS LITTLE PLACE IN MODERN-- HAS LITTLE PLACE IN MODERN OBSTETRICS !OBSTETRICS ! www.doctor.sdwww.doctor.sd
  • 5.  B]B] INHALATION ANALGESIA :INHALATION ANALGESIA :  [1][1] NITROUS OXIDENITROUS OXIDE ;MIXED WITH AIR IN THE;MIXED WITH AIR IN THE MINNIT APPARATUS AND WITH OXYGENMINNIT APPARATUS AND WITH OXYGEN {50 : 50} IN THE ENTONOX{50 : 50} IN THE ENTONOX  [2][2] TRICHLORETHYLENETRICHLORETHYLENE ; ITS QUALITY OF; ITS QUALITY OF ANAESTHESIA IS SIMILAR TO ENTONOX.ANAESTHESIA IS SIMILAR TO ENTONOX.  [3][3] METHOXYFLURANEMETHOXYFLURANE ; IS SIMILAR TO THE; IS SIMILAR TO THE A/M ,USED IN A MIXTURE OF 0.35 IN AIR INA/M ,USED IN A MIXTURE OF 0.35 IN AIR IN CARDIFF INHALER.CARDIFF INHALER. www.doctor.sdwww.doctor.sd
  • 6.  C]C] NARCOTIC ANALGESICSNARCOTIC ANALGESICS ::  [1][1] PETHIDINEPETHIDINE ; I.M. 50-100MG WITH ONSET 10-15M; I.M. 50-100MG WITH ONSET 10-15M LASTING 3-4HRS,MAY CAUSE;LASTING 3-4HRS,MAY CAUSE;  ~MATERNAL VOMITING,NAUSEA AND~MATERNAL VOMITING,NAUSEA AND POSSIBLE ADDICTIONPOSSIBLE ADDICTION  ~PLACENTAL TRANSFER-- NEONATAL~PLACENTAL TRANSFER-- NEONATAL DEPRESSANT FEEDING FUNCTIONDEPRESSANT FEEDING FUNCTION  [2][2] PENTAZOCINEPENTAZOCINE; 50-60MG IM,LESS INCIDENCE OF; 50-60MG IM,LESS INCIDENCE OF VOMITING.HAS A HALLUCINOGENIC SIDE EFFECTS.VOMITING.HAS A HALLUCINOGENIC SIDE EFFECTS.  [3][3] MEPTAZINOLMEPTAZINOL; HAS LESS DEPRESSANT; HAS LESS DEPRESSANT RESPIRATORY EFFECT.MORE VOMITING.RESPIRATORY EFFECT.MORE VOMITING.  # REMEMBER NALAXONE AS AN OPIATE# REMEMBER NALAXONE AS AN OPIATE ANTAGONIST = 40-200mG FOR THE NEONATEANTAGONIST = 40-200mG FOR THE NEONATE www.doctor.sdwww.doctor.sd
  • 7.  D]D] CONDUCTION ANALGESIACONDUCTION ANALGESIA ::  LOCAL ANAESTHESIALOCAL ANAESTHESIA ;;  SIDE-EFFECTS: # MATERNAL=CNS-- DROWSINESS,SEVERESIDE-EFFECTS: # MATERNAL=CNS-- DROWSINESS,SEVERE CONVULSIONSCONVULSIONS  CVS-- BRADICARDIA, HYPERTENSION,CVS-- BRADICARDIA, HYPERTENSION, CARDIAC ARREST(BLOCKING Na CHANNELS)CARDIAC ARREST(BLOCKING Na CHANNELS)  # FETAL=ALL CROSS THE PLACENTA-- REDUCE# FETAL=ALL CROSS THE PLACENTA-- REDUCE PLACENTAL CIRCULATION.PLACENTAL CIRCULATION.  [1][1] INFILTRATION WITH LOCAL ANAESTHETICINFILTRATION WITH LOCAL ANAESTHETIC; MOST; MOST COMMONLY USED.QUITE SAFE.COMMONLY USED.QUITE SAFE.  [2][2] NERVE BLOCKS;NERVE BLOCKS; a) PUDENDAL BLOCK = USINGa) PUDENDAL BLOCK = USING TRANSVAGINAL OR TRANSPERINEAL APPROACH.TRANSVAGINAL OR TRANSPERINEAL APPROACH. b) PARACERVICAL BLOCK = USED IN FIRSTb) PARACERVICAL BLOCK = USED IN FIRST ST.OF LABOUR.MAY CAUSE FETAL BRADICARDIA.ST.OF LABOUR.MAY CAUSE FETAL BRADICARDIA.  [3][3] SPINAL(SUBARACHNOID) BLOCK;SPINAL(SUBARACHNOID) BLOCK; USED COMMONLY NOWUSED COMMONLY NOW FOR CAESAREAN SECTION AND OTHER PELVICFOR CAESAREAN SECTION AND OTHER PELVIC PROCEDURES.PROCEDURES.  [4][4] EPIDURAL BLOCK(EXTRADURALEPIDURAL BLOCK(EXTRADURAL); FOR 1st ST. OF LABOUR); FOR 1st ST. OF LABOUR NERVES TO BE BLOCKED T10-L1,FOR 2nd ST.-- S2-5.NERVES TO BE BLOCKED T10-L1,FOR 2nd ST.-- S2-5. www.doctor.sdwww.doctor.sd
  • 8. www.doctor.sdwww.doctor.sd
  • 9.  E]E] GENERAL ANAESTHESIA :GENERAL ANAESTHESIA :  IMPORTANT ASPECTSIMPORTANT ASPECTS; G.A. IS STILL ASSOCIATED; G.A. IS STILL ASSOCIATED WITH SIGNIFICANT MORBIDITY & MORTALITY DUEWITH SIGNIFICANT MORBIDITY & MORTALITY DUE TO MANY FACTORS;TO MANY FACTORS;  a) MATERNAL STARVATION, AS WELL ASa) MATERNAL STARVATION, AS WELL AS PRESENCE OF STOMACH CONTENTS WILLPRESENCE OF STOMACH CONTENTS WILL INCREASEINCREASE  GASTRIC ACIDITY= THIS NEEDS ANTACIDS {MgGASTRIC ACIDITY= THIS NEEDS ANTACIDS {Mg TRISILICATE ,Mg & ALUMINIUM HYDROXIDE,TRISILICATE ,Mg & ALUMINIUM HYDROXIDE, SODIUMSODIUM  CITRATE}. H2-RECEPTOR BLOCKERSCITRATE}. H2-RECEPTOR BLOCKERS {CIMETIDINE & RANITIDINE} ARE VERY EFFECTIVE{CIMETIDINE & RANITIDINE} ARE VERY EFFECTIVE ANTIACIDS.ANTIACIDS.  b) AORTOCAVAL COMPRESSION; USE ALWAYSb) AORTOCAVAL COMPRESSION; USE ALWAYS SLIGHT LEFT LATERAL TILT.SLIGHT LEFT LATERAL TILT. www.doctor.sdwww.doctor.sd
  • 10.  E]E] GENERAL ANAESTHESIA :GENERAL ANAESTHESIA :  IMPORTANT ASPECTSIMPORTANT ASPECTS; G.A. IS STILL ASSOCIATED; G.A. IS STILL ASSOCIATED WITH SIGNIFICANT MORBIDITY & MORTALITY DUEWITH SIGNIFICANT MORBIDITY & MORTALITY DUE TO MANY FACTORS;TO MANY FACTORS;  a) MATERNAL STARVATION, AS WELL ASa) MATERNAL STARVATION, AS WELL AS PRESENCE OF STOMACH CONTENTS WILLPRESENCE OF STOMACH CONTENTS WILL INCREASEINCREASE  GASTRIC ACIDITY= THIS NEEDS ANTACIDS {MgGASTRIC ACIDITY= THIS NEEDS ANTACIDS {Mg TRISILICATE ,Mg & ALUMINIUM HYDROXIDE,TRISILICATE ,Mg & ALUMINIUM HYDROXIDE, SODIUMSODIUM  CITRATE}. H2-RECEPTOR BLOCKERSCITRATE}. H2-RECEPTOR BLOCKERS {CIMETIDINE & RANITIDINE} ARE VERY EFFECTIVE{CIMETIDINE & RANITIDINE} ARE VERY EFFECTIVE ANTIACIDS.ANTIACIDS.  b) AORTOCAVAL COMPRESSION; USE ALWAYSb) AORTOCAVAL COMPRESSION; USE ALWAYS SLIGHT LEFT LATERAL TILT.SLIGHT LEFT LATERAL TILT. www.doctor.sdwww.doctor.sd