© Springer India 2016
Alpesh Gandhi, Narendra Malhotra, Jaideep Malhotra, Nidhi Gupta and Neharika Malhotra Bora (eds.)Principles of Critical Care in Obstetrics10.1007/978-81-322-2686-4_3535. Anesthesia and Pain Relief in Critically Ill Obstetric Patient
(1)
Saraswat Nursing Home, Agra, India
(2)
Ob/Gyn Moolchand Hospital, Agra, India
(3)
ICMCH, Agra, India
Perianesthetic Evaluation
Conduct a focused history and physical examination before providing anesthesia care:
Maternal health and anesthetic history
Relevant obstetric history
Airway and heart and lung examination
Baseline blood pressure measurement
Back examination when neuraxial anesthesia is planned or placed
A communication system should be in place to encourage early and ongoing contact between obstetric providers, anesthesiologists, and other members of the multidisciplinary team.
Order or require a platelet count based on a patient’s history, physical examination, and clinical signs; a routine intrapartum platelet count is not necessary in the healthy parturient.
Order or require an intrapartum blood type and screen or crossmatch based on maternal history, anticipated hemorrhagic complications (e.g., placenta accreta in a patient with placenta previa and previous uterine surgery), and local institutional policies; a routine blood crossmatch is not necessary for healthy and uncomplicated parturients.
The fetal heart rate should be monitored by a qualified individual before and after administration of neuraxial analgesia for labor; continuous electronic recording of the fetal heart rate may not be necessary in every clinical setting and may not be possible during initiation of neuraxial anesthesia.
Aspiration Prophylaxis
Oral intake of modest amounts of clear liquids may be allowed for uncomplicated laboring patients.
The uncomplicated patient undergoing elective cesarean delivery may have modest amounts of clear liquids up to 2 h before induction of anesthesia.
The volume of liquid ingested is less important than the presence of particulate matter in the liquid ingested.
Patients with additional risk factors for aspiration (e.g., morbid obesity, diabetes, difficult airway) or patients at increased risk for operative delivery (e.g., nonreassuring fetal heart rate pattern) may have further restrictions of oral intake, determined on a case-by-case basis.
Solid foods should be avoided in laboring patients.
Patients undergoing elective surgery (e.g., scheduled cesarean delivery or postpartum tubal ligation) should undergo a fasting period for solids of 6–8 h depending on the type of food ingested (e.g., fat content).
Before surgical procedures (i.e., cesarean delivery, postpartum tubal ligation), practitioners should consider timely administration of nonparticulate antacids, H2-receptor antagonists, and/or metoclopramide for aspiration prophylaxis.
Anesthetic Care for Labor and Delivery
Neuraxial Techniques: Availability of Resources
When neuraxial techniques that include local anesthetics are chosen, appropriate resources for the treatment of complications (e.g., hypotension, systemic toxicity, high spinal anesthesia) should be available.
If an opioid is added, treatments for related complications (e.g., pruritus, nausea, respiratory depression) should be available.
An intravenous infusion should be established before the initiation of neuraxial analgesia or anesthesia and maintained throughout the duration of the neuraxial analgesic or anesthetic.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
