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Obstetric Anesthesia Handbook
Sanjay Datta, Bhavani Shankar Kodali, Scott Segal
Verlag Springer-Verlag, 2010
ISBN 9780387886022 , 470 Seiten
5. Auflage
Format PDF, OL
Kopierschutz Wasserzeichen
Geräte
Preface to the Fifth Edition
5
Preface to the First Edition
6
Contents
7
1 Maternal Physiological Changes During Pregnancy, Labor, and the Postpartum Period
9
Changes in the Hematological System
9
Clinical Implications
10
Changes in the Cardiovascular System
11
Clinical Implications
12
Changes in the Respiratory System
13
Clinical Implications
14
Changes in the Gastrointestinal System
15
Clinical Implications
17
Changes in the Renal System
17
Clinical Implications
17
Changes in the Central and Peripheral Nervous Systems
18
Clinical Implications
19
Changes in the Endocrine System
19
Changes in the Musculoskeletal System
20
Changes in the Dermatological System
20
Changes in Mammary Tissue
20
Changes in the Ocular System
20
2 Local Anesthetic Pharmacology
23
Chemistry
23
Physicochemical Properties
25
Other Factors Affecting Local Anesthetic Activity
27
Volume and Concentration
27
Addition of Vasoconstrictor Agents
28
Site of Injection
28
Bicarbonate
29
Mixtures of Local Anesthetics: Chloroprocaine and Other Drugs
29
Pregnancy
30
Temperature
30
Toxicity of Local Anesthetics
30
Systemic Toxicity: CNS
30
Systemic Toxicity: Cardiovascular System
31
Peripheral Neurotoxicity
32
Adverse Effects on the Fetus
34
3 Perinatal Pharmacology
37
General Principles
38
The Mother
40
Site of Administration
40
Addition of Epinephrine
40
Maternal Volume of Distribution and Clearance
40
Uteroplacental Blood Flow
41
Maternal Protein Binding
41
Maternal pH and Drug pKa
41
The Placenta
42
Area of Transfer and Diffusion Distance
42
Molecular Weight and Spatial Configuration of Drugs
42
Protein Binding and Lipid Solubility of Drugs
42
Metabolism of Drugs
43
The Fetus
43
Uptake
43
Distribution
44
Fetal Liver
44
Progressive Dilution of Umbilical Vein in Blood Concentration
44
Extensive Right-to-Left Shunt of the Fetal Circulation
44
Summary
46
4 Drug Interactions and Obstetric Anesthesia
48
Drugs Used for Maternal Indications
49
Antibiotics
49
Antiepileptic Drugs
49
Enzyme Induction
51
Sympatholytic and Sympathomimetic Drugs
51
Sympatholytic Drugs
51
Sympathomimetic Drugs
52
Antiasthmatic Drugs
53
Xanthine Derivatives
53
Corticosteroids
54
Histamine H2 Receptor Blockers
54
Psychotropic Agents
54
Phenothiazine, Thioxanthenes, and Butyrophenones
55
Tricyclic Antidepressants
55
Monoamine Oxidase Inhibitors
56
Lithium Carbonate
58
Serotonin Reuptake Inhibitors
58
Anti-fungal Drugs
59
Drugs Used During Labor and Delivery
60
Tocolytic Drugs
60
Magnesium Sulfate
60
Mimetic Drugs
60
Calcium Channel Blockers
61
Prostaglandin Inhibitors
61
Oxytocin Antagonist
61
Hypotensive Drugs
62
Hydralazine
62
Nitroglycerin
62
Nitroprusside
62
Trimethaphan
62
Uterotonic Agents
62
Oxytocin
62
Ergot Alkaloids
63
Prostaglandins
64
Local Anesthetics
64
Narcotics
65
Drugs Used for Fetal Indications
65
5 Uteroplacental Blood Flow
71
Measurement of Uteroplacental Blood Flow
72
Clinical Implications of the Uteroplacental Circulation: Gas Exchange Across the Placenta
72
Factors That Can Alter Uteroplacental Blood Flow
75
Uterine Contraction
75
Pain and Stress of Labor
75
Regional Anesthesia
75
Pathological Conditions
76
Pharmacological Agents
76
Intravenous Induction Agents
76
Inhalation Agents
77
Local Anesthetics
78
Epinephrine
79
Opioids
79
Vasopressors
79
Antihypertensive Agents
80
Tocolytic Drugs (Magnesium Sulfate, Beta Adrenergic Agonists, Indomethacin)
81
Summary
81
6 Pain of Labor and Delivery
86
Pain Score of Labor Pain
88
7 Non-pharmacological Methods for Relief of Labor Pain
90
Hypnosis
91
Psychoanalgesia
92
Natural Childbirth
92
Psychoprophylaxis
92
Leboyer Technique
93
Acupuncture
93
Transcutaneous Electrical Nerve Stimulation (TENS)
94
Aromatherapy
95
Touch and Massage
95
Maternal Movements and Positional Changes
96
Water Birthing
97
Summary
97
8 Relief of Labor Pain by Systemic Medications and Inhalational Agents
99
Opioids
99
Morphine
100
Meperidine
100
Fentanyl
102
Remifentanil
103
Sedatives and/or Tranquilizers
104
Barbiturates
104
Phenothiazines
104
Benzodiazepines
104
Diazepam
105
Midazolam
105
Dissociative Medications
105
Amnestic Agents
106
Neuroleptanalgesia
106
Agonist and Antagonist Agents
106
Inhalation Analgesia
107
9 Relief of Labor Pain by Regional Analgesia/Anesthesia
111
Epidural Analgesia
113
Anatomy of the Epidural Space
113
Contents of the Epidural Space
114
Site of Action
115
Techniques
115
Epidural Analgesia Procedure
116
Multiorifice Versus Uniorifice Epidural Catheters
117
Changes in the Position of Epidural Catheters Associated with Patient Movement
118
Test Dose
119
Initial Bolus Administration
122
Maintenance of Labor Analgesia
122
Local Anesthetic and Opioid Infusion
124
Possible Block-Related Problems
125
Inadequate Perineal Analgesia
125
Asymmetric Sensory Block
125
Diminishing Analgesia
125
Dense Motor Block
126
Patchy Block
126
Miscellaneous
127
Spinal Anesthesia
127
Continuous Spinal Anesthesia
127
Combined Spinal/Epidural (CSE)
128
Monitoring Following Administration of Regional Analgesia
130
Contraindications
130
Complications of Regional Analgesia
131
Paresthesia
131
Accidental Dural Puncture
131
Treatment of Headache Following Accidental Dural Puncture
132
Conservative Management
132
Epidural Saline
132
Prophylactic Blood Patch
133
Therapeutic Blood Patch
133
Experimental and Alternative Techniques
135
Subdural Injection
135
Massive Epidural Analgesia
136
Accidental Intravascular Injection
136
Methemoglobinemia
137
Broken Epidural Catheter
137
Shivering
137
Horners Syndrome
137
Backache
138
Major Neurologic Injury
138
Obstetric Causes
139
Anesthesia-Related Causes
142
Other Methods of Regional Anesthesia
145
Caudal Anesthesia
146
Paracervical Block
146
Lumbar Sympathetic Block
146
Pudendal Block
146
Summary
147
10 Effects of Epidural Analgesia on Labor and the Infant
154
Epidural Analgesia and Progress of Labor
154
Methodological Difficulties
155
Initiation of the Block
155
Duration of Labor
156
Instrumental Vaginal Delivery (Forceps, Vacuum)
156
Cesarean Delivery
157
Patient Satisfaction and Neonatal Outcome
158
Effect of Epidural Analgesia on Maternal Temperature and the Newborn
158
Epidural Analgesia and Breastfeeding
160
Summary
160
11 Fetal Monitoring
165
Antepartum Monitoring
165
Biophysical Profile
166
Nonstress Test (NST)
166
Contraction Stress (Oxytocin Challenge) Test
167
Doppler Velocimetry
167
Assessment of Fetal Lung Maturity
167
Uterine Contraction Monitoring
168
Fetal Heart Rate Monitoring
169
Baseline Heart Rate
169
Baseline Variability
171
Fetal Heart Rate Pattern (Periodic Changes)
172
Early Decelerations
172
Variable Decelerations
174
Late Decelerations
176
Other Modalities
178
Fetal Scalp Blood Sampling
178
Fetal Pulse Oximetry
178
Implications for Anesthesia Care
178
12 Anesthesia for Cesarean Delivery
181
Regional Anesthesia
182
Spinal Anesthesia (Subarachnoid Block)
182
Problems Associated with Spinal Anesthesia
183
Medications for Spinal Anesthesia
192
Summary of Spinal Anesthesia for Cesarean Section
193
Contraindications for Spinal Anesthesia for Cesarean Section
194
Epidural Anesthesia
195
Problems Associated with Epidural Anesthesia
195
Complications of Epidural Anesthesia
196
Contraindications for Epidural Anesthesia
196
Local Anesthetics for Epidural Anesthesia
197
Summary of Epidural Anesthesia for Cesarean Section
198
Cardiovascular Complications of Bupivacaine and Neurological Complications of 2-Chloroprocaine
199
Differences Between Spinal and Epidural Anesthesia for Cesarean Delivery
202
Combined Spinal Epidural (CSE) Technique
202
General Anesthesia
203
Complications of General Anesthesia
204
Maternal Aspiration
204
Airway Management
204
Choice Between Regional and General Anesthesia when Difficult Airway Is Anticipated
209
Regional Anesthesia
209
General Anesthesia
210
Effect of General Anesthesia on the Baby
210
Underlying Physiology
211
Pharmacological Effects
213
Maternal Awareness
217
Summary of General Anesthesia for Cesarean Delivery
217
Air Embolism During Cesarean Delivery
218
Postoperative Pain Relief
219
Intravenous Method
219
Neuraxial Narcotics
219
Summary
220
13 Neonatal Resuscitation
233
Physiologic Adaptation to Extrauterine Life
234
Cardiovascular System
234
Respiratory System
237
Thermoregulation
238
General Principles of Neonatal Resuscitation
238
Evaluation of the Neonate: The Apgar Score
240
Steps in Neonatal Resuscitation
241
Airway
242
Breathing
244
Circulation
244
Drug Therapy
245
Indications for Volume Expanders
245
Other Drugs
246
Unusual Specific Causes of Neonatal Respiratory Problems
246
Choanal Atresia
247
Upper Airway Obstruction
247
Anomalies of the Larynx
248
Anomalies of the Trachea
248
Diaphragmatic Hernia
248
Pneumothorax
249
Summary
249
14 High-Risk Pregnancy: Maternal Comorbidity
251
Endocrine Disorders
253
Diabetes Mellitus
253
Pathophysiological Changes
254
Anesthetic Management
256
Hyperthyroidism
260
Anesthetic Management
260
Pheochromocytoma
261
Cardiac Disease
261
Anesthetic Management
262
Respiratory Problems
267
Bronchial Asthma
267
Cesarean Section
268
Regional Anesthesia
268
General Anesthesia
268
Cystic Fibrosis
269
Neurological Problems
270
Paraplegia
271
Anesthetic Management
272
Cerebrovascular Accidents
272
Anesthetic Management
272
Multiple Sclerosis
273
Anesthetic Management
273
Space-Occupying Lesions (Brain Tumors)
275
Labor and Delivery
275
Cesarean Section
275
Epilepsy
276
Myasthenia Gravis
276
Labor and Delivery
277
Cesarean Delivery
277
Neonatal Myasthenia Gravis
278
Renal Disorders
278
Physiological Changes
278
Anesthetic Management
279
Labor and Delivery
279
Cesarean Section
279
Hematological Disorders
280
Sickle Cell Disease
282
Anesthetic Management
282
Idiopathic Thrombocytopenia
282
Von Willebrand Disease
283
Hypercoaguable States
283
Protein C and Protein S Deficiency, Phospholipid and Cardiolipin Antibodies
283
Factor V Leiden Mutation
283
Autoimmune Disease
285
Rheumatoid Arthritis
285
Anesthetic Management
286
Systemic Lupus Erythematosus
286
Anesthetic Management
286
Maternal Addiction
287
Alcohol
288
Major Problems
288
Anesthetic Management
288
Amphetamines
288
Anesthetic Management
288
Cocaine
288
Anesthetic Management
289
Infectious Diseases
290
Genital Herpes
290
Infection with the Human Immunodeficiency Virus
291
Anesthetic Technique
293
Risk to the Anesthesiologist
293
Psychiatric Disorders
293
Clinical Implications
294
Malignant Hyperthermia
295
Anesthetic Management
295
Regional Anesthesia
295
General Anesthesia
296
Obesity
296
Anesthetic Management
297
Labor and Delivery
297
Elective Cesarean Section
297
General Anesthesia
298
Summary
298
15 High-Risk Pregnancy:Pregnancy-Related Problems
304
Maternal-Related Issues
305
Antepartum Hemorrhage
305
Placenta Previa
305
Abruptio Placentae
308
Postpartum Hemorrhage
310
Lacerations
311
Retained Placenta
311
Uterine Inversion
312
Uterine Rupture
314
Vaginal Birth After Cesarean Delivery (VBAC) (also called Trial of Labor After Cesarean Delivery; TOLAC)
314
Anesthetic Management
314
Pregnancy-Induced Hypertension
315
Definition and Terminology
315
Pathogenesis
316
Pathophysiology
317
Magnesium Therapy
320
Fluid Balance and Cardiovascular Function
321
Monitoring
326
Anesthetic Management
326
HELLP Syndrome
333
Eclampsia
334
Embolism in Pregnancy
335
Thromboembolism
335
Amniotic Fluid Embolism
335
Venous Air Embolism
336
Fetal-Related Issues
337
Prematurity
337
Tocolytic Agent Therapy
338
Anesthetic Management of Prematurity
343
Postmaturity
345
Anesthetic Management of Postmaturity
345
Breech Presentation
345
Multiple Gestations
346
Twins
346
Triplets or Quadruplets
346
Anesthetic Management
346
Fetal Distress (Nonreassuring Fetal Status)
347
Maternal Causes
347
Placental Causes
347
Fetal Causes
347
Diagnosis
348
Anesthetic Management
348
Intrauterine Fetal Death
349
Transfusion-Related Issues (Newer Transfusion Protocols)
350
Recombinant Factor VIIa
351
Summary
352
16 Non-delivery Obstetric Procedures
358
Cervical Cerclage
358
Anesthetic Options
359
Regional Anesthesia
359
General Anesthesia
360
Cerclage Removal
360
Dilation and Evacuation (DE)
361
Anesthetic Options
361
Postpartum Tubal Ligation
363
Timing of Tubal Ligation
363
Physiologic Changes of Pregnancy in the Postpartum Period
364
Anesthetic Techniques
364
Epidural Anesthesia
364
Spinal Anesthesia
365
General Anesthesia
366
Postoperative Pain Relief
367
17 Anesthesia for Nonobstetric Surgery During Pregnancy
369
Maternal Safety
370
Fetal Well-Being
370
Acute Exposure to Anesthetics
371
Chronic Exposure to Anesthetics
371
Effect of Anesthetics on the Fetus
372
Sedative and Hypnotic Agents
372
Opioids
373
Muscle Relaxants
373
Local Anesthetics
373
Oxygen and Carbon Dioxide
374
Inhalation Anesthetics
374
Effects on the Fetal Brain: Behavioral Teratogenicity
376
Continuation of the Pregnancy
377
Recommendations for Minimizing Chances of Abortion or Premature Labor
377
Intrauterine Surgery
379
18 Assisted Reproductive Technology
386
In Vitro Fertilization Process
387
Effect of Anesthetics on IVF Process
388
Propofol and Thiopentone
388
Nitrous Oxide
389
Inhalational Anesthetic Agents
389
Local Anesthetic Agents
390
Opioids, Benzodiazepines, and Ketamine
391
Antiemetic Agents
391
Anesthetic Techniques for Ultrasound-Guided Transvaginal Oocyte Retrieval
391
Complications of IVF Procedure
393
Ovarian Hyperstimulation Syndrome (OHSS)
393
Other Complications
393
19 Maternal Mortality and Morbidity
398
Appendix A: Guidelines for Regional Anesthesia in Obstetrics
403
19.1 GUIDELINE I
403
19.2 GUIDELINE II
403
19.3 GUIDELINE III
404
19.4 GUIDELINE IV
404
19.5 GUIDELINE V
404
19.6 GUIDELINE VI
405
19.7 GUIDELINE VII
405
19.8 GUIDELINE VIII
405
19.9 GUIDELINE IX
405
19.10 GUIDELINE X
405
19.11 References
406
Appendix B: Practice Guidelines for Obstetric Anesthesia
407
19.1 Methodology
408
19.1.1 A. Definition of Perioperative Obstetric Anesthesia
408
19.1.2 B. Purposes of the Guidelines
408
19.1.3 C. Focus
408
19.1.4 D. Application
408
19.1.5 E. Task Force Members and Consultants
409
19.1.6 F. Availability and Strength of Evidence
409
19.1.7 Guidelines
411
I. Perianesthetic Evaluation
411
II. Aspiration Prevention
413
III. Anesthetic Care for Labor and Vaginal Delivery
414
IV. Removal of Retained Placenta
422
V. Anesthetic Choices for Cesarean Delivery
423
VI. Postpartum Tubal Ligation
426
VII. Management of Obstetric and Anesthetic Emergencies
427
VIII. Perianesthetic Evaluation
430
IX. Aspiration Prophylaxis
431
X. Anesthetic Care for Labor and Delivery
432
XI. Removal of Retained Placenta
434
XII. Anesthetic Choices for Cesarean Delivery
434
XIII. Postpartum Tubal Ligation
436
XIV. Management of Obstetric and Anesthetic Emergencies
436
19.2 Methods and Analyses
437
19.3 References
443
Appendix C: Optimal Goals for Anesthesia Care in Obstetrics
445
19.1 References
449
Index
450
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