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 features of obstetric drugs proper to the anaesthetist are coated, from notion, all through being pregnant, to after start care. The emphasis is on pre-empting difficulties and maximising caliber of care. The authors have pointed out over a hundred and fifty capability problems every one coated in sections: concerns raised and administration techniques, with key issues extracted into containers for speedy reference. a bit on organisational points resembling list retaining, education, protocols and directions makes this a huge source for any labour ward or medical institution facing pregnant girls. awarded in a transparent, dependent structure, this publication may be priceless 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 useful.
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Extra info for Analgesia, Anaesthesia and Pregnancy: A Practical Guide
The overall effect of these changes is a decrease in gastro-oesophageal barrier pressure, with a concomitant increase in risk of regurgitation and aspiration of gastric contents. • Some 75–85% of pregnant women complain of heartburn during the third trimester, and a significant number will have a demonstrable hiatus hernia. • Gastric emptying is not delayed during pregnancy. • There is some evidence that gastric volume is increased, and the pH of the intragastric volume may be lower than in the non-pregnant individual.
6 Major nerves of the pelvis. Adapted with permission from Holdcroft & Thomas: Principles and practice of obstetric anaesthesia and analgesia, Blackwell Publishing, 2000. 1. Motor innervation of lower limbs by myotomes and peripheral nerves Joint Movement Myotomes Nerve supply Hip Flexion L1–3 L2–4 L5–S2 L5–S2 L5–S2 L2–4 Lumbar plexus Femoral nerve Sacral plexus Sciatic nerve Sacral plexus Obturator nerve Extension Abduction Adduction Knee Extension Flexion L2–4 L5–S2 S1–2 Femoral nerve Sciatic nerve.
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. The only standard anaesthetic drug that has excited controversy in recent years is nitrous oxide, because of its effects on methionine synthase and DNA metabolism. Although there is a theoretical risk of its affecting the fetus, there is no evidence to support this clinically and many, if not most, authorities would now consider its use acceptable.