By Steve Yentis, Surbhi Malhotra
A completely up-to-date version of this well-established sensible consultant to obstetric analgesia and anaesthesia initially released by way of W. B. Saunders. All points of obstetric medication proper to the anaesthetist are lined, from perception, all through being pregnant, to after beginning care. The emphasis is on pre-empting difficulties and maximising caliber of care. The authors have pointed out over a hundred and fifty strength problems each one coated in sections: matters raised and administration concepts, with key issues extracted into bins for speedy reference. a bit on organisational features resembling list preserving, education, protocols and directions makes this an enormous source for any labour ward or health center facing pregnant girls. provided in a transparent, established layout, this ebook should be valuable to trainee anaesthetists in any respect degrees and to skilled anaesthetists who come upon obstetric sufferers. Obstetricians, neonatologists, midwives, nurses and working division practitioners wishing to increase or replace their wisdom also will locate it hugely important.
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Additional resources for Analgesia, Anaesthesia and Pregnancy: A Practical Guide
Hosp Med 2003; 64: 210–13. Steer P, Flint C. Physiology and management of normal labour. BMJ 1999; 318: 793–6. 14 G A S T R I C FU N C T I O N A N D F E E D I N G I N LA B O U R Physiological changes in pregnancy affect the volume, acidity and emptying of gastric secretions as well as sphincter mechanisms in the lower oesophagus. Interventions in labour such as analgesia may also affect these changes adversely. General anaesthesia is occasionally necessary in emergency situations, and the presence of a full stomach (and thus the risk of aspiration of gastric contents) should always be assumed in such patients (see Chapter 56, Aspiration of gastric contents, p.
The supine position should be avoided at all times, although the efficacy of lateral tilt when the uterus is still small is uncertain. Particular attention should be paid to general assessment as for emergency surgery in any patient. g. ). Although general anaesthesia involves administration of more drugs with possible effects on the fetus, it also allows administration of volatile agents that relax the uterus. In general, drugs with good safety records during pregnancy should be used; most anaesthetic drugs do not have licences for use in pregnancy (mainly because of the costs involved in extending their licences), but newer drugs should probably be avoided until more is known about their actions.
Since most conditions that might be amenable to intrauterine surgery are rare or uncommon and already associated with poor outcome, it is difficult to demonstrate that outcome after fetal surgery is better than that after conventional postpartum therapy, because any expected improvement will be small. Surgery is technically difficult because of the small size of the fetus and its mobility when small, but leaving the surgery until later may result in increased end-organ damage caused by the malformation.