Obstetric anaesthesia and analgesia

Abstract

This chapter discusses the anaesthetic management of the pregnant patient, for labour analgesia as well as surgical intervention. It begins with a description of the physiological and pharmacological changes of pregnancy. It describes methods of labour analgesia, including remifentanil, and epidural analgesia and its complications such as post-dural puncture headache. It describes anaesthesia for Caesarean section (both regional and general), failed intubation, antacid prophylaxis, post-operative analgesia, retained placenta, in utero fetal death, hypertensive disease of pregnancy (pre-eclampsia, eclampsia, and the hypertension, elevated liver enzymes, and low platelets (HELLP) syndrome), massive obstetric haemorrhage, placenta praevia and morbidly adherent placenta (placenta accreta, increta, and percreta), amniotic fluid embolism, maternal sepsis, and maternal resuscitation. It discusses co-morbidity in pregnancy, such as obesity and cardiac disease, and the patient who requires non-obstetric surgery while pregnant. It provides information on safe prescribing in pregnancy and breastfeeding.

Henti Jantung pada Seksio Sesarea

“…Kelahiran yang singkat (termasuk seksio sesarea) merupakan salah satu penyebab terjadinya henti jantung pada kehamilan. 1 Emboli paru merupakan penyebab utama kematian maternal terkait kehamilan, terutama pada masa postpartum. 2 Pada masa plasentasi awal, sinsisiotrofoblas mempenetrasi vasa uterus maternal untuk membentuk sirkulasi uteroplasenter primer.…”

Accidental dural puncture-perioperative management

“…The possible options include conversion to spinal anaesthesia through the same epidural needle (no postoperative analgesia), placement of the epidural catheter in another interspace (motor blockade even with sensory dose due to seepage of the drug through rent in the dura), and intrathecal catheterization, ation through the dural hole, or less commonly abandoning the procedure. [ 2 3 ]…”