PRF. TARIK Y. ZAMZAMIMD, CABOG, fICS PROFESSOR & OB/GYNCONSULTANTKAUHSCHOOL OF MEDICINE Email.tzamzami@kaau.edu.sa

Analgesia & Anesthesia in ObstetricsPain relief in labor:is it important !

Advantages:Child birthPain-Fear-Anxiety Syndrome

Surgical VS Obstetrics PatientsPatientUterine contractionsDurationPreparation

What Are The Criteria? Fetal homeostasisSimplicitySafety

I- Obstetric AnalgesiaNarcotic injectionInhalation

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

Narcotic AnalgesiaPethidineDose 50 - 100 mgRoute I/MFrequency 3 - 4 hoursPromethazine 25 mg I/M

Side EffectMother: .Euphoria .Nausea&Vomiting .DizzinessFetus: .Respiratory depression

Narcotic AntagonistNaloxon hydrochloride (Narcan)ActionDose 10 g/kg

Inhalation AnalgesiaAnesthetic agent: .Entonoxe .Nitrous oxide .50:50 %

Epidural ExcellentPortal entry: L3 - L4Labor&vaginal delivery: Block T10 - S5Cesarean section: Block T8 - S1A.Agent: MarcainDuration: 1 - 3 hours

IndicationsMaternal requestMalpresentationMultiple pregnancyPreterm laborCardiac disease

ContraindicationsPatient refusedLocal sepsisAnti-coagulant therapyObstructive cardiomyopathyBleedingInadequate staffPrevious surgery

ComplicationsHypotensionBladder dysfunctionDural tapIncomplete analgesia

Spinal AnalgesiaPort entry: L3 - L4Space: subarachnoid Level of blockade: T10 - T6

IndicationsManual removal of placentaCesarean section

ComplicationsTotal spinal blockadeSpinal headache HypotensionBladder dysfunction

Local AnesthesiaPudendal blockLocal infiltration

Pudendal BlockTechniqueIndicationDisadvantages

Local InfiltrationTechniqueIndication

General AnesthesiaIs one of the leading cause of maternal death in obstetrics

ComplicationsRespiratory depression of new bornPostpartum hemorrhageGastric aspiration

Mendelson Syndrome

Effect of Pregnancy on StomachDelay gastric emptyingRelaxation of gastro-esophageal sphincterRaised intragastric press

Clinical Features of Aspiration PneumoniaTachypneaBronchospasmHypotensionCyanosisAtelectasis

Prevention of Mendelson SyndromeWell trained AnesthetistNPO for 12 hoursEating&drinking are prohibited during laborAntacid