obstetric anesthesia and analgesia
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Obstetric Anesthesia
and Analgesia
By: Edderlyn D. LamarcaSaint John Colleges
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Analgesia
reduces or decreases awareness ofpain
Anesthesia
causes partial or complete loss ofsensation
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Pain During Labor and Delivery
Pain during labor is caused primarily by
uterine muscle contractions and somewhat
by pressure on the cervix. This painmanifests itself as cramping in the
abdomen, groin, and back, as well as a tired,
achy feeling all over. Some womenexperience pain in their sides or thighs as
well.
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I. Analgesics (Narcotic)
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Narcotics may decrease the progress of
labor by reducing the force or rate ofcontractions ( this is dose dependant as well
as dependant on the timing of the dosesBiggest effect is in the latent phase
In the active phase of labor narcotics my
speed up the progress of labor by decreasinganxiety and decreasing catecholamines.
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Meperidine (Demerol)
Most common analgesic in North Americaand Europe
IM up to 100mg-onset 40-50 min
IV up to 50mg-onset5-10 min
Quick placental transfer life 3 hours in mother (up to23 in fetus)
Metabolized to normeperidine
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Morphine
IV 20min onset time
Last 4-6 hours
Very high likelihood on neonatal depression
Not used for pain in Labor
Used for sedation in latent phase10-15mg IM
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Pentazocine (Talwin)
No advantage over other narcotics
Respiratory depression
Weak opiate antagonist, strong opiate agonist
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Butorphanol (Stadol)
Synthetic analgesic like pentazocine (mixedagonist/antagonist
5 times more potent than morphine (40Xmore than Demerol)
Dose 1-2 mg
IM 10min onset, IV 1-2min onset
Duration 2-4 hours
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Butorphanol cont.
Metabolites are inactive
Less nausea and vomiting
Causes drowsiness
Dont give after Demerol
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Alphaprodine (Nisentil)
Rapid onset of action 5-10 min sub Q, 1-2min IV(IM absorbtion is unpredictable)
Short duration 1-2 hoursRepeated doses result in long duration of actionbecause it is accumulated in tissue and slowly released
Maternal respiratory depression is commonDose 10-20mg IV
Dose 30mg sub Q
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Fentanyl (Sublimaze)
Synthetic opoid 1000 times more potent thanmeperidine
Rapid onset
Brief durationRepeated doses result in drug accumulation andlong duration of action
Dose 50-100micrograms IVNot used in labor
Causes sudden and profound respiratory depression
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II. Anesthetic
Anesthetic refers to a technique or
medication that partially or completelyeliminates sensation or feeling
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2 types of nerve-blocking
anestheticsLocal anesthetics block sensory nerve
pathways at the organ level.
Regional anesthetics block sensory nerve
pathways along the course of tissues.
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Level of anesthesia for cesarean
and vaginal delivery.
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NERVE-BLOCKING
ANESTHETICS USED IN
OBSTETRICS
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produces anesthesia only in the area whereinjected. It is used in the superficial nerves of theperineum to make or repair episiotomy.
Lidocaine1percent drug normally used and isshort acting.
Local anesthetics are used frequently for delivery.
a. Local Anesthetics
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b. Regional anesthetics
Regional anesthetics include:
paracervical block
pudendal block saddle block (low spinal)
caudal or lumbar epidural.
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Paracervical block
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Pudendal blockPudendal block is an injection of local anesthetic
on both sides of the vagina. It is administered just
prior to delivery. It numbs the perineal area, vulva,and the vagina. It is used frequently in labor and
delivery in combination with local anesthesia.
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Bilateral blockage of the pudendalnerve will result in complete anesthesia
over the perineum
Pudental Block
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Saddle block (low spinal)is an injection of anesthetic agent directlyinto the spinal canal below the spinalcolumn to cause loss of sensation below
the injection site.patient has to sit up on the table with legscrossed or hanging over the side.
It numbs the abdominal and pelvic areasbelow the umbilicus to include theperineum, legs, and feet.
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The patient will usually feel contractions.Side Effects are severe maternalhypotension due to vasodilation and
decreased oxygen to the fetus as a result ofhypotension.
Cont. Saddle block
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Saddle block
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Caudal or lumbal epidural
is an injection of anesthetic agent in the
peridural space through the sacral hiatus.
is an injection of anesthetic agent on top ofthe dura space through the 3rd and 4th or5th lumbar space.
It numbs the abdominal and pelvic areas
below the umbilicus to the midthigh.
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Cont. Caudal
The patient doesn't feel contractions or
perineal stretching.
The urge to push may be blocked,although the ability is still present.
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Cont. CaudalADVANTAGES:
good pain relief
the patient is alert and cooperative
there is decreased danger of neonatal
depression.
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Cont. Caudal
SIDE EFFECTS:
Hypotension secondary to peripheralvasodilation.
Sensory changes and loss of the ability to move
lower extremities.
Ringing in the ears, lightheadedness, circumoral(around mouth) tingling, numbness, metallic
taste, and seizures.
Burning at the site of injection.
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GENERALANESTHESIA
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General AnesthesiaGeneral anesthesia produces loss ofsensation and loss of consciousness. It is
seldom indicated for uncomplicatedvaginal delivery. It is used in cases of fetal
distress requiring immediate delivery and
used for C-section when spinal anesthesiais contraindicated.
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Cont. G.ADISADVANTAGES:
(1)The patient is unable to participate.
(2) It rapidly crosses the placenta causing fetal
anesthesia, respiratory depression, and possibleanoxia (loss of oxygen).
(3) There is increased risk of maternal aspiration -
- evaluate how recently the patient has eaten.
(4) There is possible hemorrhage since nitrousoxide yields uterine relaxation.
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-End-
Prepared by: Edderlyn D. Lamarca
Saint John Colleges