PRF. TARIK Y. ZAMZAMI MD, CABOG, fICS PROFESSOR & OB/GYN CONSULTANT KAUH SCHOOL OF MEDICINE

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

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

Surgical VS Obstetrics Patients n Patient n Uterine contractions n Duration n Preparation

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

I- Obstetric Analgesia n Narcotic injection n Inhalation

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

Narcotic Analgesia n Pethidine n Dose mg n Route I/M n Frequency hours n Promethazine 25 mg I/M

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

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

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

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

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

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

Complications n Hypotension n Bladder dysfunction n Dural tap n Incomplete analgesia

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

Indications n Manual removal of placenta n Cesarean section

Complications n Total spinal blockade n Spinal headache n Hypotension n Bladder dysfunction

Local Anesthesia n Pudendal block n Local infiltration

Pudendal Block n Technique n Indication n Disadvantages

Local Infiltration n Technique n Indication

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

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

Mendelson Syndrome

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

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

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