A Practical Approach to Obstetric Anesthesia

 

Description:

Successfully combining the comprehensive depth of a textbook and the user-friendly features of a practical handbook, A Practical Approach to Obstetric Anesthesia, 2nd Edition, is a portable resource for both experienced and novice clinicians. Focusing on clinical issues in obstetric anesthesia, it uses an easy-to-follow outline format for quick reference, enhanced with numerous tables, figures, and photographs. The use of color in this edition highlights key information and improves readability for daily practice and study.Key Features:•Presents the most up-to-date information available in obstetric anesthesiology, including guidance on both routine and complicated patient care.•Features new chapters on ultrasound and echocardiographic techniques, trauma, management of the opioid dependent parturient, and maternal morbidity and mortality.•Covers pharmacology and physiology, antepartum considerations, labor and delivery, postpartum issues, and disease states in obstetric patients, including a chapter on obesity and pregnancy, as well as guidelines from national organizations.•Provides Clinical Pearls throughout, as well as Key Points in each chapter and current references for further study.Now with the print edition, enjoy the bundled interactive eBook edition, which can be downloaded to your tablet and smartphone or accessed online and includes features like:•Complete content with enhanced navigation•Powerful search tools and smart navigation cross-links that pull results from content in the book, your notes, and even the web•Cross-linked pages, references, and more for easy navigation•Highlighting tool for easier reference of key content throughout the text•Ability to take and share notes with friends and colleagues•Quick reference tabbing to save your favorite content for future use

 

 

Table of Contents:

 

Section I: Pharmacology and Physiology

Chapter 1: Physiologic Changes of Pregnancy

Chapter 1 Introduction

I. Cardiovascular system

Table

1. 1: Changes in blood volume and its consequences during pregnancy

Table

1. 2: Hemodynamic changes during pregnancy compared to nonpregnant women

II. Respiratory system

Table

1. 3: Blood gases during pregnancy

Table

1. 4: Changes in respiratory physiology at term compared to nonpregnant women

Table

1. 5: Causes of increased oxygen consumption during pregnancy

III. Hematologic system

Table

1. 6: Hematologic changes of normal pregnancy

IV. Gastrointestinal system

V. Hepatic function

Table

1. 7: Liver function tests in normal pregnancy

VI. Renal system

VII. Endocrine system

VIII. Musculoskeletal

IX. Central nervous system

X. Anesthetic implications of maternal physiologic changes during pregnancy

References

Chapter 2: Uteroplacental Anatomy, Blood Flow, Respiratory Gas Exchange, Drug Transfer, and Teratogenicity

Chapter 2 Introduction

I. Anatomy

Figure

2. 1

II. Uteroplacental circulation

Figure

2. 2

III. Respiratory gas exchange (see fig.

2. 2)

Figure

2. 3

Figure

2. 4

IV. Nutrient/drug transfer

Table

2. 1: Placental drug transfer

V. Teratogenicity

Table

2. 2: U.S. Food and Drug Administration requirements for pregnancy and lactation labeling of prescription drugs and biological products

Table

2. 3: Congenital malformations associated with drugs commonly administered during pregnancy

References

Chapter 3: Local Anesthetics and Toxicity

Chapter 3 Introduction

I. Chemical structure

Figure

3. 1

Table

3. 1: Commonly used local anesthetics and attendant physiochemical properties

II. Mechanism of action

III. Differential blockade

Table

3. 2: Peripheral nerve fiber classification

IV. Additives

V. Effect of pregnancy on local anesthetic action

VI. Pharmacokinetics

VII. Local anesthetics rapidly cross the placenta

VIII. Systemic toxicity

Table

3. 3: Early and late signs of local anesthetic toxicity

Table

3. 4: Maximum recommended single doses of local anesthetics

Figure

3. 2

IX. Other types of reactions may occur

Acknowledgment

References

Chapter 4: Obstetric Medications

Chapter 4 Introduction

I. Tocolytic medications

Figure

4. 1

Table

4. 1: β-Adrenergic receptor effects

Table

4. 2: Effects of increasing plasma magnesium levels

II. Uterotonic medications

Figure

4. 2

References

Section Ii: Antepartum Considerations

Chapter 5: Ethical and Legal Considerations in Obstetric Anesthesia

Chapter 5 Introduction

I. Introduction to ethics

II. Informed consent

III. Other consent issues

IV. Professional negligence: the law

V. Informed consent: the law

VI. Litigation specific to obstetric anesthesia

VII. Disclosure and apology

VIII. Maternal autonomy and fetal beneficence

Summary

References

Chapter 6: Nonobstetric Surgery during Pregnancy

Chapter 6 Introduction

I. Incidence and anesthetic concerns specific to pregnancy

II. Teratogenicity of anesthetic agents

Table

6. 1: Documented teratogens

III. Preoperative plan and counseling

Table

6. 2: Principles for anesthetic management of the parturient

Table

6. 3: Principles for anesthetic management of the parturient >24 weeks’ gestation

IV. Intraoperative anesthetic management

V. Postoperative care

VI. Special situations

Summary

Table

6. 4: Common fetal interventions

References

Section Iii: Labor and Delivery

Chapter 7: Fetal Assessment and Monitoring

Chapter 7 Introduction

I. Physiologic basis of fetal monitoring

II. Electronic fetal monitoring

III. Interpretation of electronic fetal monitoring

IV. Antepartum fetal monitoring

Table

7. 1: Conditions associated with increased risk of perinatal morbidity due to fetal asphyxia in which antepartum fetal surveillance may be of benefit

Table

7. 2: Biophysical profile

V. Intrapartum fetal surveillance

Figure

7. 1

Figure

7. 2

Figure

7. 3

Figure

7. 4

Table

7. 3: Classification of decelerations

Figure

7. 5

Figure

7. 6

Figure

7. 7

Figure

7. 8

Figure

7. 9

Table

7. 4: Three-tier interpretation system of fetal heart rate patterns

Table

7. 5: Interventional maneuvers for nonreassuring fetal heart rate patterns

VI. Medication and anesthetic effects on fetal surveillance

Table

7. 6: Special circumstances

References

Chapter 8: Maternal Infection and Fever

Chapter 8 Introduction

I. Fever in pregnancy

II. Noninfectious fever in parturients

III. Infectious causes of fever in parturients

IV. Sepsis and septic shock

Table

8. 1: Treatment of septic shock (surviving sepsis guidelines)

V. Neuraxial anesthesia for the febrile parturient

References

Chapter 9: Non-neuraxial Analgesic Techniques

Chapter 9 Introduction

I. Nonpharmacologic methods of pain relief in labor

Figure

9. 1

Figure

9. 2

Figure

9. 3

II. Non-neuraxial pharmacologic methods of pain relief

Summary

Table

9. 1: Suggested technique for intermittent inhalation of oxygen/nitrous oxide mixtures

Figure

9. 4: Patient-controlled analgesia (PCA) with remifentanil for labor.

Table

9. 2: Remifentanil studies for labor analgesia

Table

9. 3: Maternal and neonatal effects of remifentanil

References

Chapter 10: Choice of Neuraxial Analgesia and Local Anesthetics

Chapter 10 Introduction

I. Pain pathways during labor

Figure

10. 1

II. Neuraxial anatomy in pregnancy

Figure

10. 2

III. Techniques for neuraxial analgesia during labor

Table

10. 1: Contraindications for neuraxial techniques during labor

Table

10. 2: Preprocedure checklist

Table

10. 3: Suggested epidural technique

Table

10. 4: Important components of aseptic technique before neuraxial anesthetic placement

Figure

10. 3

Figure

10. 4

Figure

10. 5

Table

10. 5: Dose ranges of commonly used opioids

Table

10. 6: Suggested patient-controlled epidural analgesia regimens

Table

10. 7: Suggested guidelines for ambulation during neuraxial analgesia

IV. Side effects and complications

References

Chapter 11: Ultrasound and Echocardiographic Techniques in Obstetric Anesthesia

Chapter 11 Introduction

I. Introduction

Table

11. 1: Scanning equipment requirements

II. Focused cardiac ultrasound

Figure

11. 1

Figure

11. 2

Table

11. 2: Sensitivity and specificity for predicting a right atrial pressure ≥10 mm Hg versus vena cava inspiratory constriction

Figure

11. 3

III. Pulmonary ultrasound

Figure

11. 4

Figure

11. 5

Table

11. 3: Sensitivity and specificity of auscultation, chest radiography, and lung ultrasonography for diagnosing lung disorders

IV. Ultrasound-guided neuraxial anesthesia

Figure

11. 6

Figure

11. 7

Figure

11. 8

Figure

11. 9

Figure

11. 10

Figure

11. 11

Figure

11. 12

Table

11. 4: Operator outcomes ultrasound- versus non–ultrasound-guided epidural analgesia

Figure

11. 13

V. Ultrasound-guided regional anesthesia (transversus abdominis plane block)

Figure

11. 14

VI. Intracranial pressure measurement (optic nerve sheath diameter)

Figure

11. 15

Figure

11. 16

VII. Gastric volume measurement

Figure

11. 17

Figure

11. 18

Figure

11. 19

VIII. Pelvic/abdominal ultrasound

Figure

11. 20

IX. Airway examination

Figure

11. 21

X. Lower extremity vein ultrasound

Figure

11. 22

References

Chapter 12: Impact of Neuraxial Analgesia on Obstetric Outcomes

Chapter 12 Introduction

I. Introduction

Table

12. 1: Benefits of neuraxial labor analgesia

II. Effects of neuraxial analgesia on the progress of labor

III. Duration of the first stage of labor

IV. Duration of the second stage of labor

Table

12. 2: Definitions of second stage arrest

V. Instrumental vaginal delivery

VI. Cesarean delivery

VII. Influence of oxytocin augmentation and ambulation on labor outcomes

VIII. Impact of neuraxial analgesia on maternal fever rates (see chapter 8, maternal infection and fever)

IX. Impact of neuraxial analgesia on breastfeeding success rates

X. Conclusion

References

Chapter 13: Anesthetic Considerations for Women Receiving Cesarean Delivery

Chapter 13 Introduction

I. Background

II. Indications for cesarean delivery

Table

13. 1: Indications for cesarean delivery

III. Surgical considerations

IV. Complications of cesarean delivery

Table

13. 2: Recommended resources for the management of obstetric hemorrhage: the American Society of Anesthesiologists Practice Guidelines for Obstetric Anesthesia

Figure

13. 1

V. Preoperative considerations

VI. Anesthetic techniques

Table

13. 3: Classifications of fetal heart rate

Table

13. 4: Contraindications to epidural or spinal anesthesia

Figure

13. 2

VII. Postoperative management (see Chapter 18, Postcesarean Analgesia)

VIII. Conclusions

References

Chapter 14: Difficult Airway Management in the Pregnant Patient

Chapter 14 Introduction

I. Introduction

II. Definitions

III. Goals and preparation for airway management during pregnancy

IV. Incidence of difficult and failed intubation

Table

14. 1: Difficult airway incidence

V. Anesthesia-related morbidity and mortality

Table

14. 2: NAP4 study: the common recurring themes resulting in adverse outcomes

VI. Maternal deaths and airway-related issues following emergence

VII. Anatomic and physiologic changes during pregnancy contributing in difficult airway management

Figure

14. 1

VIII. Airway assessment

Figure

14. 2

Figure

14. 3

Figure

14. 4

Figure

14. 5

Table

14. 3: LEMON: airway assessment method

Figure

14. 6

IX. Morbid obesity in pregnancy and the airway

Figure

14. 7

X. Aspiration of gastric contents

XI. Anesthetic management in obstetric patients with a predicted difficult airway

XII. Management of pregnant patient with an unanticipated difficult airway

Figure

14. 8

Figure

14. 9

Table

14. 4: Difficult airway cart

XIII. Extubation and postanesthesia care unit airway issues

XIV. Conclusion

References

Chapter 15: Anesthesia for Multiple Gestation and Breech Presentation

Chapter 15 Introduction

Anesthesia for multiple gestation: I. Introduction

Figure

15. 1

II. National guidelines

III. Maternal adaptation to multiple gestation pregnancy

Table

15. 1: Exaggerated physiologic changes in multiple gestation pregnancy

IV. Obstetric conditions and concerns for multiple gestation pregnancy

Table

15. 2: Complications of multiple gestation pregnancy

V. Timing of delivery for multiple gestation pregnancy

VI. Preterm birth in multiple gestation pregnancy

VII. Delivery route for multiple gestation pregnancy

VIII. Anesthesia for vaginal delivery in multiple gestation pregnancy

IX. Anesthesia for cesarean delivery in multiple gestation pregnancy

X. Pharmacologic therapies for multiple gestation pregnancy

XI. Costs of multiple gestation pregnancy

Anesthesia For breech presentation: I. Introduction

II. American college of obstetricians and gynecologists committee opinion 2006: breech presentation management69

III. Historical perspective for breech presentation management

IV. Demographics for breech presentation

Figure

15. 2

Table

15. 3: Risk factors for breech presentation

V. Obstetric management for breech presentation

Table

15. 4: Indications for breech cesarean delivery in singleton pregnancy

VI. Complications of vaginal breech delivery (see table

15. 5)

Table

15. 5: Problems associated with persistent breech presentation

VII. Cesarean delivery for breech presentation

VIII. External cephalic version for breech presentation

Table

15. 6: Factors associated with external cephalic version failure

IX. Labor following external cephalic version

X. Anesthesia for external cephalic version in breech presentation

XI. Costs for external cephalic version

XII. Neonatal resuscitation in breech presentation delivery

References

Chapter 16: Obstetric Emergencies

Chapter 16 Introduction

I. Nonreassuring fetal status

Table

16. 1: Basic causes of fetal compromise in the peripartum period

Table

16. 2: Obstetric management of nonreassuring fetal status

II. Peripartum bleeding

Table

16. 3: Clinical signs of hemorrhagic shock in pregnancy

Table

16. 4: Transfusion-related risks

Figure

16. 1

Table

16. 5: Laboratory diagnosis of disseminated intravascular coagulation

Table

16. 6: Number of prior cesarean deliveries and risk of placenta accreta in patients with placenta previa

Figure

16. 2

Table

16. 7: Complications of arterial embolization procedures

III. Intrapartum emergencies

Table

16. 8: Differential diagnosis: amniotic fluid embolus

References

Chapter 17: Newborn Resuscitation

Chapter 17 Introduction

I. Neonatal adaptations to extrauterine life

Figure

17. 1

Figure

17. 2

II. Anticipating the depressed newborn

Table

17. 1: Antepartum factors associated with need for neonatal resuscitation

Table

17. 2: Intrapartum factors and events associated with need for neonatal resuscitation

Table

17. 3: Categorization of fetal heart rate tracing

III. Evaluating the neonate

Table

17. 4: Apgar scoring system

Table

17. 5: Normal umbilical arterial and venous blood gas values

IV. Resuscitation of the neonate

Table

17. 6: Essential supplies for neonatal resuscitation

Figure

17. 3

Figure

17. 4

Table

17. 7: Recommendation of endotracheal tube (ETT) size

Figure

17. 5

Table

17. 8: Medications for neonatal resuscitation

V. Special resuscitation circumstances

Figure

17. 6

References

Section Iv: Postpartum Issues

Chapter 18: Postcesarean Analgesia

Chapter 18 Introduction

I. Introduction

II. Multimodal therapy

III. Medications: oral, systemic, neuraxial, and regional administration

Table

18. 1: Recommended intravenous patient-controlled analgesia (IV PCA) opioid doses for postcesarean analgesia

Table

18. 2: Recommended single doses of epidural opioids for postcesarean analgesiaa

Table

18. 3: Recommended single doses of intrathecal opioids for postcesarean analgesiaa

Table

18. 4: Prophylaxis and treatment of nausea and vomiting

IV. Summary

References

Chapter 19: Management of Postdural Puncture Headache

Chapter 19 Introduction

I. Scope of the problem

II. Pathophysiology

III. Risk factors for postdural puncture headache

IV. Diagnosis of postdural puncture headache

V. Differential diagnosis of postpartum headache

Table

19. 1: Differential diagnosis of postpartum headache

VI. Prevention and treatment of postdural puncture headache after accidental dural puncture

VII. Recommendations

Summary

Recommended Reading

References

Chapter 20: Neurologic Deficits Following Labor and Delivery

Chapter 20 Introduction

I. Neurologic injury

Table

20. 1: Frequency of immediate serious complications occurring in 145,550 epidurals given for obstetric analgesia or anesthesia

Table

20. 2: Frequency of transient and permanent neurologic deficits in neuraxial anesthesia

Figure

20. 1

II. History and initial evaluation

III. Basic anatomy

Figure

20. 2

IV. Common obstetric neuropathies

Table

20. 3: Peripheral nerve injuries in obstetric patients

Table

20. 4: Obstetric nerve injury and implications

Figure

20. 3

Figure

20. 4

V. Ischemic injury to the spinal cord

Figure

20. 5

VI. Types of lesions

VII. Diagnosis and treatment of neuropathies (see fig.

20. 5 and table

20. 5)

Table

20. 5: Electromyography and evoked potential after nerve injury

Figure

20. 6

VIII. Approach to patients with peripheral nerve injuries

Table

20. 6: Differential diagnosis of prolonged neural blockade

IX. Complications related to spinal fluid leakage

Figure

20. 7

Figure

20. 8

Figure

20. 9

Figure

20. 10

X. Infectious complications of neuraxial blocks

Figure

20. 11

XI. Epidural hematoma

Table

20. 7: Summary of guidelines for neuraxial anesthesia with anticoagulation therapy

XII. Recommendations

References

Chapter 21: Postpartum Tubal Ligation

Chapter 21 Introduction

I. American society of anesthesiologists practice guidelines for obstetric anesthesia: recommendations for postpartum sterilization

Table

21. 1: Summary of American Society of Anesthesiologists Practice Guidelines for Obstetric Anesthesia: postpartum sterilization

II. Postpartum anatomic and physiologic changes

III. Timing of postpartum tubal sterilization

Table

21. 2: Factors affecting timing of tubal sterilization

IV. Surgical considerations relevant to the anesthesiologist

Figure

21. 1

Figure

21. 2

V. Anesthetic considerations

Table

21. 3: Factors to consider when attempting epidural reactivation

Figure

21. 3

References

Section V: Disease States

Chapter 22: Hypertensive Disorders of Pregnancy

Chapter 22 Introduction

I. Differential diagnosis and definitions

Table

22. 1: Signs and symptoms of preeclampsia

II. Epidemiology

III. Risk factors (see table

22. 2)

Table

22. 2: Risk factors for development of preeclampsia

IV. Etiology

V. Pathophysiology

Table

22. 3: Signs and symptoms of preeclampsia

VI. Obstetric management

Table

22. 4: Effects of magnesium at different plasma levels

Table

22. 5: Useful antihypertensive agents in pregnancy

VII. Anesthetic considerations

VIII. Mode of delivery and anesthetic technique

Figure

22. 1

IX. Postpartum care

References

Chapter 23: Endocrine Disorders

Chapter 23 Introduction

I. Diabetes mellitus

Table

23. 1: Insulin and insulin analogs

II. Thyroid disorders

Table

23. 2: Changes in thyroid function test results in normal pregnancy and in thyroid disease states

Table

23. 3: Causes of hyperthyroidism in pregnancy

Table

23. 4: Drugs and their mechanism for treatment of hyperthyroidism

III. Pituitary disorders

Table

23. 5: Causes of hypopituitarism in the pregnant woman

IV. Adrenal disorders

V. Conclusion

References

Chapter 24: Thrombophilias/Coagulopathies

Chapter 24 Introduction

I. Overview of normal hemostatic coagulation

Figure

24. 1

Figure

24. 2

Figure

24. 3

Figure

24. 4

Figure

24. 5

II. Physiologic changes of coagulation in pregnancy

Table

24. 1: Summary of hemostatic changes at term pregnancy

III. Measurements of coagulation in pregnancy

Figure

24. 6

IV. Thrombophilia

Table

24. 2: Risk of venous thromboembolism with different thrombophilias in pregnancy

Table

24. 3: Recommended thromboprophylaxis for parturient with inherited thrombophilia

Table

24. 4: Different recommended anticoagulation regimes

Table

24. 5: Guidelines for timing of neuraxial anesthesia in the anticoagulated patient

V. Disorders of coagulation

Summary

Table

24. 6: Comparison of different anticoagulants used in pregnancy

Table

24. 7: Anesthetic management of parturients with inherited bleeding disorders

Table

24. 8: Precipitants of disseminated intravascular coagulation in pregnancy

References

Chapter 25: Cardiac Disease in the Obstetric Patient

Chapter 25 Introduction

I. Overview

Table

25. 1: New York Heart Association classification of cardiovascular disease

Table

25. 2: Modified World Health Organization classification with corresponding maternal cardiac risk

Figure

25. 1

II. Valvular heart disease: congenital and acquired

Figure

25. 2

Figure

25. 3

Figure

25. 4

Figure

25. 5

Table

25. 3: Factors affecting pulmonary vascular resistance (PVR)

III. Congenital heart disease in the adult parturient

Table

25. 4: Tachyarrhythmias associated with adult congenital heart disease

Figure

25. 6

Figure

25. 7

Figure

25. 8

Figure

25. 9

IV. Primary pulmonary hypertension

Figure

25. 10

V. Cardiomyopathy

Figure

25. 11

Figure

25. 12

Figure

25. 13

VI. Ischemic heart disease in pregnancy

VII. Cardiac dysrhythmias and pregnancy

Figure

25. 14

VIII. Cardiopulmonary resuscitation in the obstetric patient

References

Chapter 26: Neurologic and Neuromuscular Disease

Chapter 26 Introduction

I. Anatomic disease

Figure

26. 1

Figure

26. 2

Table

26. 1: Idiopathic causes of structural scoliotic curves

Table

26. 2: Contributors to clinical deterioration in pregnant patients with uncorrected scoliosis and curves >25 degrees

Table

26. 3: Possible complications associated with epidural catheter placement in patients with scoliosis and instrumentation

Figure

26. 3

Table

26. 4: Signs and symptoms of autonomic hyperreflexia

Table

26. 5: Signs and symptoms of an intracranial neoplasm

II. Vascular disease

III. Immunologic disease

Table

26. 6: Medications known to exacerbate myasthenic symptoms

IV. Epilepsy

Table

26. 7: Classification of seizures

V. Conclusion

References

Chapter 27: Renal and Hepatic Disease in the Pregnant Patient

Chapter 27 Introduction

I. Introduction

II. Renal disease during pregnancy

Table

27. 1: Renal changes during pregnancy

Table

27. 2: Renal disease outcome: quality initiative classification of renal disease

Table

27. 3: Systemic effects of uremia

Table

27. 4: Monitoring of renal disease during pregnancy

Table

27. 5: Signs and symptoms of acute renal decompensation

Table

27. 6: Systemic effects of chronic renal disease

I. Renal failure associated with pregnancy

Table

27. 7: Etiology and laboratory findings of acute kidney injury

Table

27. 8: Causes of acute kidney injury in pregnancy

III. Liver disease

Table

27. 9: Characteristics of liver disease in pregnancy

Table

27. 10: Causes of acute hepatic failure in obstetric patients

Table

27. 11: Modified Swansea criteria for diagnosis of acute fatty liver of pregnancy

Table

27. 12: Signs and symptoms of hemolysis, elevated liver enzymes, low platelets

References

Chapter 28: Obstetric Anesthesia for Parturients with Respiratory Diseases

Chapter 28 Introduction

I. Introduction

Figure

28. 1

Table

28. 1: Respiratory alterations during pregnancy

II. Asthma

Table

28. 2: Classification of asthma severity

Figure

28. 2

Figure

28. 3

Figure

28. 4

III. Pulmonary embolism during pregnancy

Figure

28. 5

IV. Amniotic fluid embolism

Table

28. 3: Common amniotic fluid embolism symptoms

V. Venous air embolism

Figure

28. 6

VI. Smoking

Table

28. 4: Smoking effects

VII. Obstructive sleep apnea

VIII. Sarcoidosis

IX. Aspiration pneumonitis

X. Cystic fibrosis

XI. Lung transplantation

XII. Restrictive lung disease

XIII. Acute respiratory distress syndrome and respiratory failure

Summary

Table

28. 5: Causes of acute respiratory distress syndrome in pregnancy

References

Chapter 29: Obesity and Pregnancy

Chapter 29 Introduction

I. High-risk patient

Figure

29. 1

Table

29. 1: Maternal comorbidities

Table

29. 2: Obstetric risk and outcomes that are increased compared to nonobese pregnancies

II. Obesity: definition and demographics

Table

29. 3: Classification of obesity using body mass index (BMI)

III. Physiologic changes of obesity and pregnancy

Table

29. 4: Signs and symptoms of sleep apnea in the pregnant patient

IV. Anesthesia for the obese pregnant woman

V. Implications for patients undergoing labor for vaginal delivery

Figure

29. 2

VI. Implications for patients undergoing cesarean delivery

Figure

29. 3

Figure

29. 4

VII. Postoperative care

VIII. Newborn

IX. Pregnancy after bariatric surgery

X. Cost

SUMMARY

References

Chapter 30: Trauma in the Obstetric Patient

Chapter 30 Introduction

I. Introduction

II. Epidemiology of trauma

III. General treatment guidelines

Figure

30. 1

IV. Limitations in assessing severity of maternal injury

V. Principles of radiologic assessment

VI. Clinical and test findings versus pregnancy outcome

VII. Anesthetic considerations

VIII. Specific mechanisms of injury

IX. Salvage therapies

Summary

References

Chapter 31: Management of the Opioid Dependent Parturient

Chapter 31 Introduction

I. Introduction

Figure

31. 1

Figure

31. 2

II. Obstetric management (see Fig.

31. 3)

Figure

31. 3

III. Neonatal abstinence syndrome

IV. Pain management during the peripartum period (see Fig.

31. 3)

Summary

Table

31. 1: Summary of studies reporting peripartum pain or anesthetic management of the opioid-dependent parturient

References

Chapter 32: Maternal Morbidity and Mortality

Chapter 32 Introduction

I. Maternal mortality

Figure

32. 1

Figure

32. 2

II. Severe maternal morbidity

III. Prevention and lessons learned

IV. Anesthesia-related maternal mortality

Table

32. 1: Pregnancy-related mortality ratio due to anesthesia in the United States and United Kingdom, 1979–2002, and United Kingdom, 2003–2011

Table

32. 2: Case fatality rates and rate ratios of anesthesia-related deaths during cesarean delivery by type of anesthesia in the United States, 1979–2002

Table

32. 3: Complications of general and neuraxial anesthesia

References

Section Vi: Guidelines from National Organizations

Chapter 33: Guidelines from National Organizations

Chapter 33 Introduction

I. Terms used to label guidance documents

II. American Society of Anesthesiologists as a leader in developing guidance documents

III. “Practice Parameter” is the American Society of Anesthesiologists term for guidance documents

IV. How should Practice Parameters be used?

V. Limitations of guidance documents

VI. How to judge/compare documents

VII. National organizations with guidance relevant to obstetric anesthesia

VIII. American society of anesthesiologists website access and relevant documents

Table

33. 1: American Society of Anesthesiologists documents specific to obstetric anesthesia practice and last updates (if noted)

Table

33. 2: Suggested resources for obstetric hemorrhagic emergencies

Table

33. 3: Suggested resources for airway management during initial provision of neuraxial analgesia

Table

33. 4: Suggested contents of a portable storage unit for difficult airway management for cesarean delivery rooms

IX. American College of Obstetricians and Gynecologists

Table

33. 5: American College of Obstetricians and Gynecologists documents relevant to obstetric anesthesia

X. American Academy of Pediatrics and American College of Obstetricians and Gynecologists Collaboration: Guidelines for Perinatal Care, Seventh Edition, 201213

XI. Relevant documents from the American Society of Regional Anesthesia and Pain Medicine ASRA official website: www.ASRA.com (see Table

33. 6)

Table

33. 6: Documents from other relevant organizations

XII. Relevant document from the American Heart Association (see Table

33. 6)

XIII. Relevant document from the Society of Obstetric Anesthesia and Perinatology (see Table

33. 6)

References

Appendix

Remarks

Glossary