2026 Obstetrics 2: M.03.02 OB Anesthesia PDF

PCC SOM PCC SOM 2026 OBSTETRICS 2 M.03.02 OB ANESTHESIA...

PCC SOM PCC SOM 2026 OBSTETRICS 2 M.03.02 OB ANESTHESIA 2026 OBSTETRICS 2 M.03.02 OB ANESTHESIA OBSTETRICS 2 LECTURE  Bleeding disorders PRINCIPLES: CESAREAN DELIVERY LECTURER: JIMMY A. BILLOD, MD MHCA  Obstetrical complications with a high risk of DATE: October 12, 2024 operative delivery A level of sensory blockade extending to the T4 dermatome  Maternal medical complications such as is desired TOPIC OUTLINE cardiopulmonary disease OBSTETRICAL ANALGESIA AND ANESTHESIA  Previous anesthetic complications depending on maternal size, 10 to 12 mg of bupivacaine in a General principles on labor pains hyperbaric solution or 50 to 75 mg of lidocaine hyperbaric Labor analgesia LABOR PAINS solution Parenteral Pudendal  labor pain is a highly individual response to variable the addition of opioids: paracervical stimuli increases the rapidity of blockade onset Neuraxial  stimuli are modified by emotional, motivational, reduces shivering OB anesthesia cognitive, social, and cultural circumstances minimizes referred pain and other symptoms such as Regional EARLY STAGE OF LABOR nausea and vomiting General preservative-free morphine, 0.1 to 0.3 mg intrathecal or 2 Postpartum analgesia caused by uterine contractions and cervical dilation to 4 mg epidural, provides pain control up to 24 hours transmitted through visceral afferent sympathetic postoperatively REGIONAL ANALGESIA GENERAL PRINCIPLES OF OB ANESTHESIA nerves entering the spinal cord from T10 through L1 LATE STAGE LABOR PAINS Various nerve blocks have been developed over the years to Is anesthesia needed during labor and delivery? provide pain relief during labor or delivery pudendal, perineal stretching transmits painful stimuli Maternal physiological responses to labor pain can influence paracervical, and neuraxial blocks such as spinal, epidural, pudendal nerve and sacral nerves S2 through S4 maternal and fetal wellbeing and labor progress. and combined spinal-epidural techniques. Cortical responses to pain and anxiety during labor are use of Anesthetic Agents complex  dose of each agent varies widely and is dependent influenced by maternal expectations for childbirth, on the particular nerve block and her age, preparation through education, emotional  physical status of the woman support, and other factors  onset, duration, and quality of analgesia can be heightened by fear and the need to move into enhanced by raising the volume or various positions  ⑪ concentration PRINCIPLES: VAGINAL DELIVERY  can be done safely only by incrementally administering small-volume boluses of the agent first stage of labor: requires a sensory block to the level of  & and carefully monitoring early warning signs of the umbilicus (T10) toxicity  Administration of these agents must be followed by second stage of labor and for operative vaginal delivery: a appropriate monitoring for adverse sensory block of S2 through S4 is usually  · reactions adequate to cover pain from perineal stretching and/or ANALGESIA AND SEDATION DURING LABOR  Equipment and personnel to manage these reactions GENERAL PRINCIPLES OF OB ANESTHESIA instrumentation. must be immediately available Maternal factors that may prompt anesthesia If uterine contractions and cervical dilatation cause  Analgesic options include continuous lumbar discomfort, pain relief is offered PUDENDAL BLOCK  Body mass index >30 kg/m2 epidural analgesia, combined spinal-epidural,  Pain with vaginal delivery arises from stimuli from  Short or thick neck or skeletal neck abnormality continuous spinal analgesia, and other blocks such as the lower genital tract  these are transmitted primarily through the  Obstructive lesions: edema, anatomical pudendal and paracervical blocks. pudendal nerve, the peripheral branches of which abnormalities provide sensory innervation to the perineum, anus,  Trauma vulva, and clitoris  Decreased range of motion in opening the mouth or  pudendal nerve passes beneath the sacrospinous small mandible ligament just as the ligament attaches to the ischial  Thyromegaly or other neck tumor spine  Severe preeclampsia syndrome NOTE TAKER: ABDELKAWI Page 1 | 7 NOTE TAKER: ABDELKAWI Page 2 | 7  PCC SOM PCC SOM 2026 OBSTETRICS 2 M.03.02 OB ANESTHESIA  Sensory nerve fibers of the pudendal nerve are 2026 OBSTETRICS 2 M.03.02 OB ANESTHESIA derived from ventral branches of the S2 through S4 SPINAL /SUBARACHNOID BLOCK CHECKLIST! 8. Which of the following is an absolute contraindication for nerves  single dose/ can be partnered with an epidural 1. What factors may prompt the need for anesthesia during neuraxial anesthesia?  Pudendal nerve block is a relatively safe and simple catheter as combined spinal-epidural analgesia/ can labor and delivery? a) Maternal coagulopathy method of providing analgesia for spontaneous be administered as a continuous infusion a) Body mass index