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PRF. TARIK Y. ZAMZAMI MD, CABOG, fICS PROFESSOR & OB/GYN CONSULTANT KAUH SCHOOL OF MEDICINE Email.tzamzami@kaau.edu.sa
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Analgesia & Anesthesia in Obstetrics Pain relief in labor: is it important !
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Advantages: n Child birth n Pain-Fear-Anxiety Syndrome
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Surgical VS Obstetrics Patients n Patient n Uterine contractions n Duration n Preparation
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What Are The Criteria? n Fetal homeostasis n Simplicity n Safety
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I- Obstetric Analgesia n Narcotic injection n Inhalation
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II- Obstetric Analgesia&Anesthesia n Regional Anesthesia:. Epidural. Spinal. Local n General Anesthesia
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Narcotic Analgesia n Pethidine n Dose 50 - 100 mg n Route I/M n Frequency 3 - 4 hours n Promethazine 25 mg I/M
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Side Effect n Mother:.Euphoria.Nausea&Vomiting.Dizziness n Fetus:.Respiratory depression
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Narcotic Antagonist n Naloxon hydrochloride (Narcan) n Action n Dose 10 µg/kg
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Inhalation Analgesia n Anesthetic agent:.Entonoxe.Nitrous oxide.50:50 %
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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: 1 - 3 hours
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Indications n Maternal request n Malpresentation n Multiple pregnancy n Preterm labor n Cardiac disease
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Contraindications n Patient refused n Local sepsis n Anti-coagulant therapy n Obstructive cardiomyopathy n Bleeding n Inadequate staff n Previous surgery
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Complications n Hypotension n Bladder dysfunction n Dural tap n Incomplete analgesia
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Spinal Analgesia n Port entry: L 3 - L 4 n Space: subarachnoid n Level of blockade: T 10 - T 6
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Indications n Manual removal of placenta n Cesarean section
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Complications n Total spinal blockade n Spinal headache n Hypotension n Bladder dysfunction
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Local Anesthesia n Pudendal block n Local infiltration
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Pudendal Block n Technique n Indication n Disadvantages
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Local Infiltration n Technique n Indication
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General Anesthesia Is one of the leading cause of maternal death in obstetrics
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Complications n Respiratory depression of new born n Postpartum hemorrhage n Gastric aspiration
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Mendelson Syndrome
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Effect of Pregnancy on Stomach n Delay gastric emptying n Relaxation of gastro-esophageal sphincter n Raised intragastric press
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Clinical Features of Aspiration Pneumonia n Tachypnea n Bronchospasm n Hypotension n Cyanosis n Atelectasis
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Prevention of Mendelson Syndrome n Well trained Anesthetist n NPO for 12 hours n Eating&drinking are prohibited during labor n Antacid
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