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Questions and Answers
What is the MAIN adverse consequence of labor pain that can lead to decreased placental perfusion?
Which of the following is a key difference between analgesia and anesthesia?
Which of the following is a key advantage of using systemic opioids for pain relief during labor, compared to neuraxial anesthesia?
Which of the following is a common side effect of systemic opioid use during labor?
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Which of the following is a key characteristic that an optimal labor opioid should have?
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Which of the following is a key difference between mu, kappa, and delta opioid receptors?
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Which of the following is a key advantage of using neuraxial anesthesia (e.g., epidural) over systemic opioids for pain relief during labor?
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What is the primary reason why the lowest possible dose of opioids should be used during labor?
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Which of the following is a common side effect of opioid use during labor that can negatively impact maternal-infant bonding and breastfeeding?
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Which of the following is a key contraindication for the use of systemic opioids during labor?
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Study Notes
Nitrous Oxide in Labor
- IV dose should not exceed 1 mg/kg in 30 minutes; psychotomimetic effects noted at doses of 10 to 20 mg IV.
- Inhaled Nitrous Oxide (NO2) is very safe for all stages of labor when administered correctly.
- Self-administration of NO2 is essential; do not hold or attach the mask unnecessarily.
- Avoid mixing NO2 with sedatives or opioids to prevent adverse effects.
Fetal and Neonatal Effects
- Nitrous oxide crosses the placenta but has no effect on fetal heart rate (FHR) tracing.
- Quickly eliminated from the neonatal lungs through breathing; no neonatal respiratory depression observed.
- No significant effects on breastfeeding during use.
Labor Effects and Procedure
- NO2 does not alter contraction frequency or labor progression.
- The mother holds the mask securely, inhaling 30 seconds before each contraction and during it, exhaling into the mask for scavenging.
- Extended high-dose exposure is unlikely in labor; however, concerns exist about potential fetal brain impact.
Occupational Safety
- Nitrous oxide is typically odorless and colorless; potential occupational hazards associated with old free flow systems.
- Risks include infertility and premature labor among dental hygienists, mitigated by modern scavenging systems which reduce exposure.
Pudendal Block
- Regional anesthesia technique targeting perineal distension and repair during labor.
- Administered using 1% lidocaine (no epinephrine), typically 10 ml per side.
- Fast-acting with effects lasting 60-90 minutes and minimal maternal/fetal risks.
- Potential complications include hematoma or systemic toxicity with IV administration.
Neuraxial Analgesia
- Includes epidural, spinal (intrathecal injection), and combined spinal/epidural techniques.
- Requires trained anesthesiologist or nurse anesthetist (CRNA) for administration.
- Contraindications include spinal column abnormalities, significant thrombocytopenia, localized infection, sepsis, and maternal instability.
Epidural Analgesia
- Most effective method for relieving labor pain with high satisfaction rates.
- Common indications for use: active labor pain, operative vaginal delivery, cesarean section, and to decrease pushing duration.
- Medications used include bupivacaine for sensory block and fentanyl/remifentanil for potent pain relief.
Epidural Side Effects
- Common fetal side effects include bradycardia and decreased FHR when administered.
- Maternal effects may involve hypotension (50% incidence) and decreased uterine blood flow.
- Incorporating pre-hydration is recommended to mitigate hypotension and vascular issues.
- Bladder distension and loss of motor control can occur; catheter placement may be necessary.
Spinal Anesthesia
- Administered in subarachnoid space, rapidly inducing analgesia (onset within 5-10 minutes).
- Limited duration of action (approximately 90 minutes) with associated risks of fetal bradycardia and maternal nausea/vomiting.
Combined Spinal/Epidural (CSE)
- Involves a "needle-through-needle" technique with rapid onset analgesia.
- Medicine deposited into both subarachnoid and epidural spaces allows for ongoing infusion, ideal for transition and active labor stages.
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Description
Learn about the safety guidelines for using inhaled nitrous oxide during labor, including correct dosage, administration methods, and its effects on the fetus and newborn. Avoid mixing with sedatives or opioids to prevent adverse reactions.
