By Steve Yentis, Surbhi Malhotra
A completely up-to-date version of this well-established useful consultant to obstetric analgesia and anaesthesia initially released by means of W. B. Saunders. All facets of obstetric medication proper to the anaesthetist are coated, from notion, all through being pregnant, to after delivery care. The emphasis is on pre-empting difficulties and maximising caliber of care. The authors have pointed out over one hundred fifty power issues each one coated in sections: matters raised and administration thoughts, with key issues extracted into bins for speedy reference. a bit on organisational features akin to list preserving, education, protocols and guidance makes this an enormous source for any labour ward or clinic facing pregnant ladies. offered in a transparent, established layout, this ebook should be helpful to trainee anaesthetists in any respect degrees and to skilled anaesthetists who come across obstetric sufferers. Obstetricians, neonatologists, midwives, nurses and working division practitioners wishing to increase or replace their wisdom also will locate it hugely valuable.
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Additional resources for Analgesia, Anaesthesia and Pregnancy: A Practical Guide
In the lateral position, the greater width of women’s hips compared with their shoulders imparts a downward slope from the caudal end of the vertebral column to the cranial end. There are seven cervical vertebrae, twelve thoracic, five lumbar, five fused sacral and three to five fused coccygeal. A number of ligaments connect them (see below). Vertebrae have the following components: • Body: this lies anteriorly, with the vertebral arch behind. It is kidney-shaped in the lumbar region. Fibrocartilaginous vertebral discs, accounting for about 25% of the spine’s total length, separate the bodies of C2 to L5.
Where possible, older drugs of which clinicians have greater experience are preferred over newer ones, and this is also true of anaesthetic agents. 16 Placental transfer of drugs 39 Licensing of drugs in pregnancy Many drugs, including anaesthetic agents, are not licensed for use in pregnancy, mainly because of the prohibitive costs to the manufacturer of performing the appropriate studies required and the relatively limited addition such licensing would make to the market. For example, the data sheets of etomidate, alfentanil and fentanyl contain the sentence ‘safety in human pregnancy has not been established’ or words to that effect, whilst those of propofol and fentanyl specifically warn against their use in obstetrics.
B-Adrenergic agonists are commonly used for this purpose, although their efficacy in this situation is uncertain and they may cause maternal tachycardia and pulmonary 14 Section 2 – Pregnancy oedema; recent evidence suggests that calcium-channel blockers such as nifedipine may be at least equally effective with a better safety profile. In general, probably the fewer drugs used overall the better. g. non-steroidal antiinflammatory drugs (which can prevent the ductus arteriosus from closing). Traditional fears about the detrimental effects of high levels of maternal oxygen by causing uteroplacental vasoconstriction are now known to be unfounded, and fetal arterial partial pressure of oxygen increases (up to a maximum of about 8 kPa (60 mmHg)) as maternal arterial oxygen content increases, so long as maternal hypotension is avoided.