PRF TARIK Y ZAMZAMI MD CABOG f ICS

PRF. TARIK Y. ZAMZAMI MD, CABOG, f. ICS PROFESSOR & OB/GYN CONSULTANT KAUH SCHOOL OF MEDICINE Email. tzamzami@kaau. edu. sa

Analgesia & Anesthesia in Obstetrics Pain relief in labor: is it important !

Advantages: n n Child birth Pain-Fear-Anxiety Syndrome

Surgical VS Obstetrics Patients n n Patient Uterine contractions Duration Preparation

What Are The Criteria? n n n Fetal homeostasis Simplicity Safety

I- Obstetric Analgesia n n Narcotic injection Inhalation

II- Obstetric Analgesia&Anesthesia n n Regional Anesthesia: . Epidural. Spinal. Local General Anesthesia

Narcotic Analgesia n n n Pethidine Dose 50 - 100 mg Route I/M Frequency 3 - 4 hours Promethazine 25 mg I/M

Side Effect n Mother: . Euphoria. Nausea&Vomiting. Dizziness n Fetus: . Respiratory depression

Narcotic Antagonist n n n Naloxon hydrochloride (Narcan) Action Dose 10 µg/kg

Inhalation Analgesia n Anesthetic agent: . Entonoxe. Nitrous oxide. 50: 50 %

Epidural n n n Excellent Portal entry: L 3 - L 4 Labor&vaginal delivery: Block T 10 - S 5 Cesarean section: Block T 8 - S 1 A. Agent: Marcain Duration: 1 - 3 hours

Indications n n n Maternal request Malpresentation Multiple pregnancy Preterm labor Cardiac disease

Contraindications n n n n Patient refused Local sepsis Anti-coagulant therapy Obstructive cardiomyopathy Bleeding Inadequate staff Previous surgery

Complications n n Hypotension Bladder dysfunction Dural tap Incomplete analgesia

Spinal Analgesia n n n Port entry: L 3 - L 4 Space: subarachnoid Level of blockade: T 10 - T 6

Indications n n Manual removal of placenta Cesarean section

Complications n n Total spinal blockade Spinal headache Hypotension Bladder dysfunction

Local Anesthesia n n Pudendal block Local infiltration

Pudendal Block n n n Technique Indication Disadvantages

Local Infiltration n n Technique Indication

General Anesthesia Is one of the leading cause of maternal death in obstetrics

Complications n n n Respiratory depression of new born Postpartum hemorrhage Gastric aspiration

Mendelson Syndrome

Effect of Pregnancy on Stomach n n n Delay gastric emptying Relaxation of gastro-esophageal sphincter Raised intragastric press

Clinical Features of Aspiration Pneumonia n n n Tachypnea Bronchospasm Hypotension Cyanosis Atelectasis

Prevention of Mendelson Syndrome n n Well trained Anesthetist NPO for 12 hours Eating&drinking are prohibited during labor Antacid