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Analgesia And Anesthesia
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Michele Mele, Valentina Bellussi, Laura Felder
For CD, neuraxial anesthesia is the anesthetic technique of choice. Spinal (intrathecal) anesthesia has advantages over epidural anesthesia, including quicker onset of surgical anesthesia, simplicity, lower total drug dose, and superior abdominal muscle relaxation. Compared with epidural anesthesia, the spinal technique is associated with a similar failure rate, need for supplemental intraoperative analgesia, need for conversion to general anesthesia intraoperatively, maternal satisfaction, need for postoperative pain relief, and neonatal intervention.
Chronic hypertension and acute hypertensive crisis
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
William F. Rayburn, Lauren Plante
Although intrapartum analgesia with narcotics may be used, attempting to manage or prevent eclampsia with profound maternal sedation is dangerous and ineffective. Epidural anesthesia is permissible when an experienced anesthesiologist is available and no coagulopathies are present. Hazards include the possibility of extensive sympatholysis with resultant decreased cardiac output, maternal hypotension, and impairment of an already compromised uteroplacental perfusion (1). The advantage, of course, is that epidural anesthesia blunts the sympathetic response to pain, which may be exaggerated in women with preexisting hypertension. Women with chronic hypertension complicated by significant cardiovascular or renal disease require special attention to intake and urine output, because they may be susceptible to fluid overload with resultant pulmonary edema.
Eclampsia and Pre-Eclampsia with Severe Features
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
Caesarean delivery is performed if IOL is not considered to be appropriate, e.g. absent or reversed umbilical artery end-diastolic flow, breech presentation, primigravida with a cervix unfavourable for IOL, delivery after IOL unlikely to occur within 12 hours, etc. Regional anaesthesia is advisable over general anaesthesia, and can be administered if the platelet count is >80 × 109/l and there is no evidence of any other coagulation abnormality. Epidural anaesthesia also offers the advantage of effective pain relief during the immediate postpartum period. Judicious fluid therapy for preloading before the administration of epidural analgesia is required to prevent acute hypotension (due to hypovolaemia) as well as pulmonary oedema (due to fluid overload and increased capillary permeability). General anaesthesia carries a risk of difficult intubation due to laryngeal oedema but may be required in the presence of coagulopathy. A sudden rise of blood pressure may occur at the time of intubation and also during recovery from general anaesthesia.
Effect of encouraging a combined spinal epidural technique for cesarean delivery anesthesia
Published in Baylor University Medical Center Proceedings, 2022
Alexa Borja, Jessica Ehrig, Kristen Vanderhoef, Kendall Hammonds, Michael P. Hofkamp
The Baylor Scott & White Research Institute institutional research board waived informed consent for this study. We searched our electronic medical record (Epic, Verona, Wisconsin) for subjects who had cesarean deliveries from May 15, 2019, through April 15, 2021, which corresponded to when we encouraged a combined spinal anesthetic technique for cesarean delivery. Subjects who received a spinal anesthetic without subsequent placement of a labor epidural were defined as having single-shot spinal anesthesia. Subjects who received a spinal anesthetic followed by placement of an epidural catheter were defined as having combined spinal epidural anesthesia. We excluded subjects for receiving neuraxial labor analgesia, puncture of the dura by a Touhy epidural needle, hysterectomy at the time of cesarean delivery, conversion to general anesthesia for reasons other than failure of the neuraxial anesthetic, and use of a lower dose of intrathecal hyperbaric bupivacaine due to maternal comorbidities. A study investigator entered data from the electronic medical record into Research Electronic Data Capture (REDCap) housed at the Baylor Scott & White Research Institute. At our institution, regional anesthesia for cesarean deliveries is performed exclusively by anesthesiology residents and attending anesthesiologists. Data were analyzed using SAS version 9.4 (SAS, Cary, NC).
Delayed versus early pushing during the second stage of labour in primigravidas under epidural anaesthesia with occipitoposterior malposition: a randomised controlled study
Published in Journal of Obstetrics and Gynaecology, 2022
Hany Saad, Ahmed M. Maged, Hadeer Meshaal, Sarah M. Hassan, Ahmed Kamel, Emad Salah
Epidural anaesthesia has been widely introduced for pain relief in labour even for routine practice (Leighton and Halpern 2002). The effect of the epidural anaesthesia on the progress of labour has often been controversed irrespective to the position of the foetal head. While early studies suggested that epidural anaesthesia may have negative impact on the course and outcome labour (Lieberman et al. 1996), recent evidence did not support these old theories (Jung and Kwak 2013). However, in cases of OP position, long anterior rotation of the foetal head requires a stronger pelvic floor muscle and adequate contractions than occipitoanterior position and epidural anaesthesia is associated with motor blockade that reduces the involuntary maternal bearing down reflex (Thorburn and Moir 1981) and may delay the second stage of labour up to two hours for nulliparous women and up to one hour for multiparous women (Hansen et al. 2002).
Retrospective analysis of 586 cases of placenta previa and accreta
Published in Journal of Obstetrics and Gynaecology, 2020
Wen Peng, Liang Shen, Shan Wang, Hongmei Wang
Epidural anaesthesia or general anaesthesia was administered for caesarean section. All of the patients who underwent balloon occlusion required general anaesthesia because these patients could not flex their legs for the administration of the epidural injection, due to the presence of the femoral catheters. Intra-arterial blood pressure was measured during the operation in all cases. Immediately after the delivery and clamping of the umbilical cord, the balloons were inflated using a predetermined volume of normal saline. The duration of the occlusion was determined and recorded to be less than 35 min in all cases. If a second occlusion was needed, an interval of 10 min was required. The balloons were routinely deflated once haemostasis was achieved, and the catheters were removed after the operation once the vital signs of the patient stabilised.