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ANESTHESIA IN OBS&GYN

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