Analgesia, Anaesthesia and Pregnancy: A Practical Guide by Steve Yentis, Surbhi Malhotra

By Steve Yentis, Surbhi Malhotra

A completely up to date variation of this well-established useful advisor to obstetric analgesia and anaesthesia initially released by way of W. B. Saunders. All facets of obstetric drugs proper to the anaesthetist are coated, from notion, 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 one hundred fifty power problems each one lined in sections: concerns raised and administration suggestions, with key issues extracted into containers for fast reference. a piece on organisational points equivalent to checklist maintaining, education, protocols and guidance makes this a massive source for any labour ward or sanatorium facing pregnant ladies. provided in a transparent, based structure, this booklet may be worthy to trainee anaesthetists in any respect degrees and to skilled anaesthetists who come across obstetric sufferers. Obstetricians, neonatologists, midwives, nurses and working division practitioners wishing to increase or replace their wisdom also will locate it hugely invaluable.

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Venous return is dependent on the competence of collateral circulation via the azygos and ovarian veins. Recent studies have demonstrated that uterine blood flow decreases primarily as a result of aortic rather than venous compression. • Central venous and pulmonary arterial pressures are unchanged during normal pregnancy. 11 Physiology of pregnancy 29 Labour and delivery • Cardiac output increases by 25–50% in labour, with an additional 15–30% increase during contractions. This increase in cardiac output is mediated through increased sympathetic nervous system activity, and is therefore significantly attenuated by epidural analgesia.

BMJ 1998; 317: 1503–6. 16 P LAC E N TAL TR A NS F E R O F D R U G S The placenta is a complex structure composed of both maternal and fetal tissues. Nevertheless, it is basically a semi-permeable biological membrane and as such obeys the laws that govern transport across such membranes. Virtually all transfer of drugs across the placenta occurs by simple diffusion, and all drugs administered to the mother will reach the fetus, albeit to a variable extent depending upon the factors discussed below.

This risk is considerably increased if she has received either regional or general anaesthesia, when she is unable to safeguard her position. • No pregnant woman should lie in the unmodified supine position at term (it is rare to find a mother who will voluntarily adopt this position). The wedged supine position and the use of lateral tilt are compromises and do not reliably 12 Aortocaval compression 31 relieve aortocaval compression. Women should be encouraged to remain sitting upright or in the full lateral position whenever possible.

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