The document discusses pain pathways and effects during labor, various analgesic options for labor pain including systemic opioids, regional techniques like epidural and spinal blocks, and considerations for both maternal and fetal safety. It provides details on specific drugs and techniques, outlining advantages and disadvantages. Regional analgesia like epidural is presented as the most effective option, allowing an alert participating mother while avoiding fetal depression from systemic drugs. Factors influencing placental drug transfer and techniques for local infiltration are also summarized.
Methods to manage labour pain.
Analgesics and anaesthetic techniques used in labour..
Newer modalities in labour pain reduction.
Coping with labour pain
Methods to manage labour pain.
Analgesics and anaesthetic techniques used in labour..
Newer modalities in labour pain reduction.
Coping with labour pain
Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive programme of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, pharmacological advances like introduction of remifentanil for patient-controlled intravenous analgesia, introduction of newer local anaesthetics and adjuvants like ropivacaine, levobupivacaine, sufentanil, clonidine and neostigmine, use of inhalational agents like sevoflourane for patient-controlled inhalational analgesia using special vaporizers, all have revolutionized the practice of pain management in labouring parturients.
This topic includes Introduction for analgesia and anesthesia used in obstetrics, maternal risk factors for anesthesia, anatomical and physiological considerations, analgesia during labour and delivery, sedatives and analgesia, opioid analgesics, combination of narcotics and antiemetics, inhalation methods, commonly used local anesthesia in obstetrics, spinal anesthesia, infiltration anesthesia, patient controlled anesthesia, psychoprophylaxis, general anesthesia for cesarean section, complication of general anesthesia and its management.
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
This topic should be known by medical practitioners as well all the pregnant mothers to a certain extend to request for pain relieving modalities.......
Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive programme of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, pharmacological advances like introduction of remifentanil for patient-controlled intravenous analgesia, introduction of newer local anaesthetics and adjuvants like ropivacaine, levobupivacaine, sufentanil, clonidine and neostigmine, use of inhalational agents like sevoflourane for patient-controlled inhalational analgesia using special vaporizers, all have revolutionized the practice of pain management in labouring parturients.
This topic includes Introduction for analgesia and anesthesia used in obstetrics, maternal risk factors for anesthesia, anatomical and physiological considerations, analgesia during labour and delivery, sedatives and analgesia, opioid analgesics, combination of narcotics and antiemetics, inhalation methods, commonly used local anesthesia in obstetrics, spinal anesthesia, infiltration anesthesia, patient controlled anesthesia, psychoprophylaxis, general anesthesia for cesarean section, complication of general anesthesia and its management.
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
This topic should be known by medical practitioners as well all the pregnant mothers to a certain extend to request for pain relieving modalities.......
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. THE LABOUR IS REPORTED TO BE ONE OF
THE MOST PAINFUL EXPERIENCES IN A
WOMAN’S LIFE.
3. Pain Pathways-
First stage of labour- uterine contraction + cervical
dilatation.
Afferent- visceral afferent from uterus (symathetic)
T 10, 11, 12, L 1 posterior segments.
Second stage- distension of pelvic floor, vagina and
perineum by descending head
Afferent- sensory fibres of S 2, 3, 4 (pudendal nerve)
4.
5. EFFECTS OF PAIN AND STRESS
release of adrenocorticotropic hormone, cortisol,
catecholamines, and b-endorphins.
b-adrenergic agents have uterine relaxant effects and
higher epinephrine levels are associated with anxiety
and prolonged labour.
animal studies indicate that both epinephrine and
nor-epinephrine can decrease uterine blood flow in
the absence of maternal heart rate and blood pressure
changes, contributing to occult fetal asphyxia.
6. Maternal psychological stress (induced by bright lights
or toe clamp) can detrimentally affect uterine blood
flow and fetal acid-base status (animal studies)
Postpartum women suffer objective deficits in
cognitive and memory function when compared with
nonpregnant women.
7. Analgesia for Labor and Delivery
Always controversial!
“Birth is a natural process”
Women should suffer!!
Concerns for mother’s safety
Concerns for baby
Concerns for effects on labor
9. ANALGESIA FOR LABOUR
Psychoprophylaxis-
nonpharmacologic method
Relaxation, concentration on
breathing, acupuncture, gentle massage, and partner
participation.
may be used alone, or in conjunction with parenteral
or regional techniques.
efficacy of these techniques is largely unproven
because of a lack of randomized clinical trials.
there are no serious safety concerns with any of these
techniques.
10. Acupuncture
Acupuncture alleviates labour pain and reduces use of
both epidural analgesia and parenteral opioids.
Arranging to have a qualified provider available at the
time of delivery may be challenging.
11. Under Water Delivery
No advantage in labour outcome or in reducing the
need for analgesia.
The request for epidural analgesia was delayed by
about 30 minutes.
Lack of trials demonstrating safety and the rare but
reported unusual complications such as fetal infection
or asphyxia.
12. Others-
Intracutaneous sterile water injections- similar gating
mechanism as acupuncture.
transcutaneous electrical nerve stimulation during
labour- made the pain less disturbing, doesn’t decrease
it.
13. Placental Transfer of Drugs:
Maternal, Drug, Placental and Fetal Factors
Lipid solubility
Molecular size
Total dose of drug
Concentration gradient
Maternal metabolism and excretion
Degree of ionization
pKa of drug, maternal and fetal pH
Protein binding - mother and fetus
Uterine blood flow
14. Sedatives
Do not possess analgesic qualities.
Used early in labour to relieve anxiety or to aid in
sleep.
Cross the placenta freely.
Barbiturates, Phenothiazines, and Benzodiazepines.
Barbiturate and benzodiazepines are not used
routinely in obstetrics.
16. Systemic Opioid Analgesia
Morphine-like pharmacological activity.
Natural- morphine and codeine
Semisynthetic- hydromorphone and heroine
Synthetic- meperidine and fentanyl
Provide sedation and a sense of euphoria.
Analgesic effect in labour is limited.
Primary mechanism of action is sedation.
17. Advantages-
Easy administration.
Inexpensive.
Avoids complications of regional block.
Does not require skilled personnel.
Few serious maternal complications.
18. Disadvantages-
All drugs easily cross placenta.
Pain relief inadequate in most cases
Maternal sedation
Nausea, vomiting, gastric stasis
Fetal heart rate effects:
Loss of beat-to-beat variability
Sinusoidal rhythm
Dose-related maternal / neonatal depression
Newborn neurobehavioral depression
20. Tramadol
Centrally acting opioid analgesic used in treating severe
pain.
Route- IV or IM
Dose- 50 mg
Emetic.
Should be given with antiemetic.
Maximum respiratory depression and low apgar score
occur in newborns that are delivered within-
3 hours after an IM administration
2 hours after an IV administration.
21. Meperidine
Meperidine 100 mg is roughly equi-analgesic to
morphine 10 mg.
Side effects- tachycardia, nausea and vomiting, and a
delay in gastric emptying.
Normeperidine - active metabolite of
meperidine, potentiating meperidine's depressant
effects in the newborn. Concentrations increase
slowly, therefore, exerts its effect on the newborn
during the second hour after administration.
Multiple doses of meperidine = greater accumulation
of both meperidine and normeperidine in fetal tissues.
22. Fentanyl
Fast-onset, short-acting synthetic opioid.
Requires frequent redosing or the use of a patient-
controlled intravenous infusion pump.
Fewer neonatal effects and less maternal sedation and
nausea.
Other opioids are nalbuphine, pentazocine,
buprenorphine and butorphanol
23. Inhalational analgesia
Easy to administer (no needles)
Nitrous oxide is administered in subanaesthetic
concentrations. (N2O 30-50%)
Analgesia without loss of consciousness.
Crosses the placenta but is eliminated efficiently, no
untoward neonatal effects.
No effects on uterine contractions.
Most effective for short term (1-2 hrs) pain relief
Most beneficial in late first stage of labour.
24. Local and regional techniques
Local infiltration
Pudendal block
Paracervical block
Paravertebral (lumbar sympathetic block)
Epidural - lumbar (caudal)
Spinal
Combined spinal-epidural (CSE)
25. Perineal Infiltration
Direct infiltration of 1% lignocaine is used for perineal
and lower vaginal lacerations.
Advance the needle and inject and aspirate to avoid
intravascular injection.
Dose of lignocaine is 3-4 mg/kg plain solution, and 7-8
mg/kg with added epinephrine.
1% solution = 10 mg/ml
For 6O kg woman total dose should not exceed 200 mg
or 20 ml.
After local infiltration one should wait 3 minutes
before proceeding.
26. Paracervical block
5 to 6 ml of a dilute solution of local anesthetic
without epinephrine (e.g., 1 percent lidocaine or 1 or 2
percent 2-chloroprocaine) is injected into the mucosa
of the cervix at the 3- and 9-o'clock positions
fetal bradycardia that follows in 2 to 70 percent of
applications
fetal acidosis and death have been reported
Paracervical block should be used cautiously at all
times and should not be used at all in mothers with
fetuses in either acute or chronic distress.
27. mechanism of postparacervical block bradycardia-
local anesthetic injected close to the uterine artery
passed to the fetus
uterine artery vasoconstriction secondary to a direct
effect of the local anesthetic on the uterine artery
local anesthetic injected directly into the uterine
musculature increases uterine tone
28. Pudendal nerve block
minor regional block, effective and very safe.
Using a 20-gauge needle, inject 5 to 10 ml of local
anesthetic just below the ischial spine.
Because the hemorrhoidal nerve may be aberrant in 50
percent of patients, some prefer to inject a portion of
the local anesthetic somewhat posterior to the spine.
Although a transperineal approach to the ischial spine
is possible, most prefer the transvaginal approach.
One-percent lidocaine or 2-percent 2-chloroprocaine
can be used
29. satisfactory for all spontaneous vaginal deliveries and
episiotomies, and for some outlet or low operative
vaginal deliveries.
The potential for local anesthetic toxicity is higher
with pudendal block compared with perineal
infiltration because of large vessels proximal to the
injection site. Aspiration before injection is
particularly important.
30. Regional Analgesia for Labor
Epidural (LA or opioids)
Spinal (LA ± opioids)
CSE- combined spinal epidural (opioids ± LA)
31. Fetal / Neonatal Effects of Regional
Analgesia in Labor
Uterine perfusion maintained.
Profound hypotension & possible fetal compromise.
LA toxicity - extremely rare.
FHR changes:
baseline variability
periodic decelerations (due to maternal
catecholamine)
Neurobehavioral effects absent with current agents.
32. Epidural Analgesia
Epidural block is the most effective and least
depressant (pharmacologic option) allowing for an
alert, participating mother.
(guidelines American College of Obs & gynae)
Primary indication is the patient's desire for pain
relief.
Medical indications during labor- selected forms of
cardiovascular and respiratory disease, and prevention
or treatment of autonomic hyperreflexia in parturients
with a high spinal cord lesion.
33. Epidural analgesia prevents increases in both cortisol
and 11-hydroxycorticosteroid levels during labor, but
systemically administered opioids do not.
Epidural analgesia also attenuates elevations of
epinephrine, norepinephrine, and endorphin levels.
35. Types-
Lumbar- routinely done
Caudal- not favoured
36. Lumbar-
Low concentrations of local anesthetic are injected at
L2-L5.
Affecting the small easily blocked sympathetic nerves
that mediate early labour pain.
Sparing the sensation of pressure and motor function
of the perineum and lower extremities.
Dose can be adjusted according to patient’s response.
37. Choice of epidural local anaesthetic
Lignocaine- rapid onset, dense motor block, risk of
cumulative toxicity with repeated doses.
Bupivacaine- good sensory block with minimal motor
effect.
No adverse effect on labour with 0.0625%
concentration
Highly protein bound, fetal blood concentrations are
lower than with other local anaesthetics.
38. Epidural Opioids in Labour
Inadequate analgesics used alone
Synergistic with local anesthetics
Speedy onset of analgesia
Improves quality of analgesia
Permits use of very dilute LA solutions
Help relieve persistent perineal pain and unblocked
segments
39. Fentanyl and Sufentanil
Rapid onset, few side effects
Sufentanil slightly more effective
No significant fetal drug accumulation
No serious adverse neonatal effects with either
40. Side effects of epidural-
hypotension
local anesthetic toxicity
allergic reaction
high or total spinal anesthesia
neurologic injury
spinal headache.
Fetal bradycardia
41. The effect of epidural analgesia on labour
progression, fetal position, and risk of cesarean
delivery is controversial.
Randomized studies support the conclusion that
epidural analgesia results in a modest prolongation of
both the first and second stages of labour.
Significant increase in the use of oxytocin for labour
augmentation.
42. Increased rate of instrumental delivery.
Several well-designed randomized studies suggest
that, in settings with baseline low rates of caesarean
delivery, epidural analgesia does not increase the risk
of caesarean delivery.
43. Epidural analgesia during labor is associated with an
increase in maternal temperature.
Dependent on the duration of exposure.
Possible mechanisms- noninfectious inflammatory
activation, changes in thermoregulation, and acquired
intrapartum infection.
44. Combined spinal epidural
Opioids ± LA
Rapid onset of intense analgesia.
Ideal in late or rapidly progressing labour.
Very low failure rate.
Less need for supplemental boluses.
Minimal motor block (“walking epidural”)
Walking epidural- Use of opioid only to allow
parturients to ambulate during labour because there is
little or no interference with motor function.
45. Early intrathecal opioids followed by continuous
epidural infusion in active labour may be a good
option for women desiring regional analgesia, offering
superior pain control until active labour has been
achieved.
46. One randomized study found that use of intrathecal
opioids increased speed of cervical dilatation and
decreased length of labour when compared with
conventional epidural.
The use of intrathecal opioids improved pain control in
early labor without increasing the risk of caesarean
delivery.
avoids maternal sedation , decreases nausea and vomiting.
comparisons of intrathecal opioid analgesia versus epidural
or parenteral opioids in labour found the use of intrathecal
opioids significantly increases the risk of fetal bradycardia .
47. Fetal heart rate should be monitored during and after
the administration of either epidural or intrathecal
medications to allow for timely intrauterine
resuscitation.
No increase in emergency caesarean delivery.
48. Conclusions
Individualize technique to patient’s goals and stage of
labour.
Optimize management for spontaneous delivery.
Provide safe, cost-effective analgesia.