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    Anesthesia For Obstetrics and Gynecology and Regional Anesthesia

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    Winy Regina
    This document discusses maternal physiology changes during pregnancy and their implications for anesthesia. It covers respiratory, cardiovascular, hematologic, and other system changes. It then summarizes different anesthesia techniques for labor/delivery, C-sections, and nonobstetric surgeries during pregnancy. Cardiopulmonary resuscitation during pregnancy is also addressed.

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    Anesthesia For Obstetrics and Gynecology and Regional Anesthesia

    Uploaded by

    Winy Regina
    45 views16 pages
    This document discusses maternal physiology changes during pregnancy and their implications for anesthesia. It covers respiratory, cardiovascular, hematologic, and other system changes. It then summarizes different anesthesia techniques for labor/delivery, C-sections, and nonobstetric surgeries during pregnancy. Cardiopulmonary resuscitation during pregnancy is also addressed.

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    Jadwal

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    This document discusses maternal physiology changes during pregnancy and their implications for anesthesia. It covers respiratory, cardiovascular, hematologic, and other system changes. It then summarizes different anesthesia techniques for labor/delivery, C-sections, and nonobstetric surgeries during pregnancy. Cardiopulmonary resuscitation during pregnancy is also addressed.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    45 views16 pages

    Anesthesia For Obstetrics and Gynecology and Regional Anesthesia

    Uploaded by

    Winy Regina
    This document discusses maternal physiology changes during pregnancy and their implications for anesthesia. It covers respiratory, cardiovascular, hematologic, and other system changes. It then summarizes different anesthesia techniques for labor/delivery, C-sections, and nonobstetric surgeries during pregnancy. Cardiopulmonary resuscitation during pregnancy is also addressed.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    You are on page 1of 16

    Anesthesia for Obstetrics and

    Gynecology and Regional Anesthesia


    Suparto
    Maternal Physiology in Pregnancy
    A. Respiratory System
    – Capillary engorgement of mucosa
    – Higher oxygen requirements:
    • Minute ventilation ↑ 45%
    • Tidal volume ↑
    • Functional residual capacity , expiratory reserve
    volume, residual volume↓ 20% ec. elevation
    diaphragm from gravid uterus
    Maternal Physiology in Pregnancy
    B. Cardiovascular System
    – Cardiac output ↑ 50% (↑ stroke vol and HR)
    – Supine hypotension occurs after 20 weeks gestation
    (aortocaval compression)
    C. Hematology
    – ↑ mineralocorticoid activity  sodium retention 
    Plasma volume↑ 40%  dilutional anemia
    – Hypercoagulable:
    – ↑ factor coagulation,

    Left Uterine Displacement 


    Maternal Physiology in Pregnancy
    D. Nervous System
    – ↑ progesterone  Minimum Alveolar Concentration
    ↓ 30% for inhalational anesthetics
    – ↓ local anesthetics requirement caused by epidural
    venous engorgement
    E. Gastrointestinal System
    – Relaxation lower esophageal sphincter and
    mechanical displacement of the stomach
    – ↑ progesterone GI tract motility ↓ by the end of
    the 1st trimester
    Anesthesia for labor and vaginal delivery
    • Nonmedicated childbirth
    • Suplemental medication: meperidine, fentanyl
    • Epidural Analgesia
    • Spinal Analgesia
    • Combined spinal-epidural
    analgesia
    Anesthesia for Cesarean Section
    • Spinal anesthesia
    • Epidural anesthesia
    • Combined spinal-epidural anesthesia
    • General anesthesia
    – Advantages
    – Disadvantages
    – Technique  RSI
    Perbandingan Anestesi Umum Dan
    Anestesi Regional
    Variabel Anestesi Umum Anestesi Regional
    Onset cepat cepat (spinal),
    lambat (epidural)
    Cardiovaskuler TD, HR dengan TD
    intubasi
    Keadaan ibu Tidak sadar Sadar
    Analgesia post Parenteral narkotik Spinal opioid
    operative
    Lama anestesi Tak terbatas Terbatas
    Kematian ibu >>> <<<

    17
    Perbandingan blok spinal dengan
    epidural
    SPINAL EPIDURAL
    Onset lebih cepat Titrasi
    Single-shot technique, Durasi lebih fleksibel
    durasi dibatasi oleh obat
    yang digunakan

    Gejolak hemodinamik lebih Gejolak hemodinamik lebih


    cepat terjadi lambat terjadi
    General Anesthesia C-section
    • IV placed, standard monitor (ECG, Pulse Oxymetri, BP)
    • Antacid nonparticulate 30ml, metoclopramide 10mg or
    ranitidine 50mg IV
    • Preoxygenated 100% 3min while OB doctor prepare and
    drape the abdomen
    • Rapid sequence intubation with induction (propofol +
    succinylcholine (muscle relaxant)
    • O2 + nitrous oxide + gas anesthetic combine for
    maintenance
    • Analgesic for post op after C section:
    – Opioid intrathecal via epidural or spinal
    – IV injection: NSAID, opioid
    Anesthesia for nonobstetric surgery during
    pregnancy
    • 0,75%-2% women undergo nonobstetric surgery
    during pregnancy
    • Maternal safety: consideration the physiologic
    changes of pregnancy begin in the 1st trimester
    • Fetal safety: if possible, surgery should be avoided
    during organogenesis period (1st trimester)
    – All elective surgery should be postponed until after
    delivery
    • In general, effort should be made:
    – To prevent preterm labor
    – Maintain uteroplacental blood flow
    – Avoid teratogenic substances
    • No anesthetic agent has been proven to be
    teratogenic in humans
    • The greater concern are: hypotension,
    hypercapnea, hypocapnea, hypoxia
    Procedures incidental to pregnancy
    • Postpone elective surgery until 6 weeks
    postpartum. If a surgical procedure must be
    performed, the 2nd trimester is the preferred
    time
    • Consult with an obstetrician preoperatively
    and continuous FHR monitoring may be used
    perioperatively
    • Use regional techniques when possible.
    CPR during pregnancy
    • More difficult and less successful than in
    nonpregnant individuals
    – after 20 weeks gestation, aortocaval compression
    making closed chest compressions less effective
    – Enlarged breasts and upward displacement of
    abdominal contents make chest compression
    more difficult
    – Increased O2 demands make hypoxia even with
    adequate ventilation
    When cardiac arrest occurs
    • Immediately secure the airway
    • Maintain left uterine displacement
    • Vasoactive medications and defibrillation as in
    the nonpregnant population
    • If the arrest occurs after 24 week gestation,
    the fetus should be delivered if CPR isn’t
    successful within 4-5 min
    • Consider open chest cardiac massage or
    cardiopulmonary bypass.

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