anaesthesia during labour by adnan akram pdf

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Anaesthesia during Labour

Adnan Akram03.11.2009

Riga. Latvia


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Types of Anaesthesia used

1. Spinal Anaesthesia2. Epidural Anaesthesia

3. General Anaesthesia4. Pudendal block

5. Paracervical block6. IV meperidine7. IM morphine


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1. Spinal Anaesthesia


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Spinal anaesthesia also known assubarachnoid anaesthesia is a form oflocal or regional anaesthesia, whichinvolves injection of an anaesthetic druginto the subarachnoid cerebrospinal fluidspace (CFS).


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Positions (a). sitting position


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Positions (b) lateral


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It is given generally through a fine needle,usually 3.5 inches (9 cm) long. For extremely

obese patients, some anaesthesiologists areknown to prefer spinal needles which areseven inches (18 cm) long


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A 25G choice needle is inserted into the introducer,

passing through the epidural space, dura, andarachnoid to the sub arachnoid space stopping

when the presence of CSF is determined. CSF is

aspirated and mixing lines are identified as achange in baricity and temperature as the localanesthetic and CSF mix in the syringe. The dose isslowly injected.


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Agents used in Spinal Anaesthesia

Local Anaesthetics

Bupvicaine HCl

Ropavacaine HClLignocaine HCl


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Bupivacaine is a local anaesthetic that stabilises theneuronal membrane and prevents the initiation andtransmission of nerve impulses. This drug is verypotent, four times that of lignocaine , and has a

rapid onset of anaesthesia with prolonged duration ofaction. Bupivacaine is suitable for continuous epiduralblockade.12-18mg, 90-120min (with epinephrine 150 mins)

Bupivacaine hydrochloride


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Ropivacaine has both anaesthetic and analgesiceffects . At higher doses it produces surgical

anaesthesia with motor block, while at lower doses itproduces a sensory block, including analgesia, withlittle motor block.

16-18mg, 90-120min

Ropivacaine Hydrochloride


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Lignocaine has the same mechanism of anaestheticaction to that of bupivacaine and ropivacaine.

75-100mg, 60-75min

Lignocaine


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1. Total Spinal Anaesthesia: hypotension, rapidlyincreasing motor block, temporarily loss of breathing, loss ofconsciousness, dilated pupils, and is preceded by respiratory

distress due to the blockade of some nerve cells.

2. High Block: nasal stiffness and difficulty breathing.

Complications of Spinal Anaesthesia


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2. Epidural Anaesthesia


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Epidural anaesthesia is a local anaesthetic infused intothe epidural (extradural) space.

The injection is usually made in the lumber region atthe L2/3 or L3/4 space.


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An 18G Touhy needle is advanced through theligamentum flavum until a loss of resistance is felton attempted injection of air or saline.

Needle


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LabourThoracic Surgery

Abdominal Surgery

Orthopaedic surgery

Indications for Epidural Anaesthesia


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The patient is injected a combination oflocal anestheticsand opioids . This combination works better than either typeof drug used alone. Common local anesthetics include

lidocaine, bupivacaine, and some derivates oflopivacaine, chloroprocaine. Common opioids includemorphine, fentanyl, sufentanil, and pathedine

Agents Used in Epidural Anaesthesia


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Spinal & Epidural Combination


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3. General Anaesthesia


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- emergency cesarean sections

- some types of forceps and other assisted deliveries.

Indications


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The new born is more effected, major sideeffects thatcan be seen are

- breathing difficulties in newborn

Side effects of GA during labour


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4. Pudendal Block


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Pudendal block is used primarily to relieve pain in thesecond and third stages of labor for both normal

and instrumental (outlet) delivery.

Indications for Pudendal Block


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Agents Used

Generally, a short-acting agent, such as lidocaine1% or prilocaine 1%, produces very satisfactoryanalgesia for 1.5-2.5 h. When analgesia of very rapid

onset is required, 2-chloroprocaine 2% can beused. The duration of this agent will, however, be nomore than 1.5 h. A volume of 20 ml should not beexceeded for a block of both nerves


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Complications

1. maternal hematoma2. systemic toxic reaction

3. trauma to the sciatic nerve

4. puncture of the rectum


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5. Paracervical Block


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Usage

Paracervical blockade may be used as a means ofreducing pain during the first stage of labour. Painassociated with uterine contraction and cervical

stretching and dilatation is transmitted from thesestructures on visceral afferents which accompanysympathetic fibres


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5 cm, 22-gauge or 25-gauge needle to inject thelignocaine solution.

First 1 mL of 0.5% lignocaine solution is injected intothe anterior or posterior lip of the cervix which hasbeen exposed by the speculum.


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Complications

The proximity of uterine blood vessels in the vaginalfornices creates maternal and fetal risks. Fetal

bradycardia occurs in 10-50% of cases.Failure rate is 24 percent


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Thankyou

anaesthesia during labour by adnan akram pdf

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