Analgesia, Anaesthesia and Pregnancy: A Practical Guide

416 Pages·2007·1.3 MB·English

by  Steve Yentis

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Analgesia, Anaesthesia and Pregnancy
Apracticalguide
A thoroughly updated edition of this well-established practical guide to
obstetricanalgesiaandanaesthesia.Allaspectsofobstetricmedicinerelevant
to the anaesthetist are covered, from conception, throughout pregnancy,
toafter-birthcare.
Theemphasisisonpre-emptingproblemsandmaximisingqualityofcare.
Theauthorshaveidentifiedover150potentialcomplicationseachcoveredin
twosections:issuesraisedandmanagementoptions,withkeypointsextracted
into boxes for quick reference. A section on organisational aspects such as
record keeping, training, protocols and guidelines makes this an important
resource for any labour ward or hospital dealing with pregnant women.
Presentedinaclear,structuredformat,thisbookwillbeinvaluabletotrainee
anaesthetists at all levels and to experienced anaesthetists who encounter
obstetricpatients.Obstetricians,neonatologists,midwives,nursesandoperat-
ingdepartmentpractitionerswishingtoextendorupdatetheirknowledgewill
alsofindithighlybeneficial.
SteveYentisisaConsultantAnesthetistatChelseaandWestminsterHospital,
LondonandHonorarySeniorLectureratImperialCollege,London.
AnneMayisaConsultantObstetricAnaesthetistatLeicesterRoyalInfirmary
NHSTrustandHonorarySeniorLecturerattheUniversityofLeicester.
SurbhiMalhotraisaConsultantAnaesthetistatStMary’sHospital,London.
FromreviewsoftheFirstEdition:
‘Thisisabookthatopenlyprofessestobea‘‘shortpracticaltext’’–andithas
achieved its objective very successfully indeed. Clearly set out with discrete
well-organizedchapters,thetextiseasytoreadandpresentsacomprehensive
overviewofadifficultfieldina‘‘user-friendly’’form.’
EuropeanJournalofAnaesthesiology
‘Thediversityoftopicsandtheirlimitedanalysismakesiteasytoreadthetext
quickly and pick up key points. At the end of each topic is a bullet point
synopsis... It is these characteristics of the book that create the practical
approach...The book...is certain to be popular given its broad authorship
andsuccinctstyle.’
BritishJournalofAnaesthesia
‘Theauthorshavesucceededinproducinganexcellentbookinastylethat
setsitapartfrom,andpossiblyabove,recentsimilarpublications....Thebook
achievesitsaimoftargetinganaesthetistsintrainingatalllevels,andwould
provide a useful handbook for both the experienced and the occasional
consultantobstetricanaesthetist.’
InternationalJournalofObstetricAnesthesia
Analgesia, Anaesthesia
and Pregnancy
A Practical Guide
Second Edition
Edited by
STEVE YENTIS,
ANNE MAY and
SURBHI MALHOTRA
WithDavidBogod,DianaBrighouseandChrisElton
CAMBRIDGEUNIVERSITYPRESS
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo
Cambridge University Press
The Edinburgh Building, Cambridge CB28RU, UK
Published in the United States of America by Cambridge University Press, New York
www.cambridge.org
Information on this title: www.cambridge.org/9780521694742
© Cambridge University Press 2007
This publication is in copyright. Subject to statutory exception and to the provision of
relevant collective licensing agreements, no reproduction of any part may take place
without the written permission of Cambridge University Press.
First published in print format 2007
ISBN-13 978-0-511-29021-3 eBook (NetLibrary)
ISBN-10 0-511-29021-7 eBook (NetLibrary)
ISBN-13 978-0-521-69474-2 paperback
ISBN-10 0-521-69474-4 paperback
Cambridge University Press has no responsibility for the persistence or accuracy of urls
for external or third-party internet websites referred to in this publication, and does not
guarantee that any content on such websites is, or will remain, accurate or appropriate.
Every effort has been made in preparing this publication to provide accurate and up-to-
date information which is in accord with accepted standards and practice at the time of
publication. Although case histories are drawn from actual cases, every effort has been
made to disguise the identities of the individuals involved. Nevertheless, the authors,
editors and publishers can make no warranties that the information contained herein is
totally free from error, not least because clinical standards are constantly changing through
research and regulation. The authors, editors and publishers therefore disclaim all liability
for direct or consequential damages resulting from the use of material contained in this
publication. Readers are strongly advised to pay careful attention to information provided
by the manufacturer of any drugs or equipment that they plan to use.
Contents
List of contributors page xiii
Preface xv
SECTION 1 – PRECONCEPTION AND CONCEPTION
1 Assistedconception 1
2 Ovarianhyperstimulationsyndrome 3
3 Anaesthesiabeforeconceptionorconfirmationofpregnancy 5
SECTION 2 – PREGNANCY
I Proceduresinearly/mid-pregnancy 7
4 Cervicalsuture(cerclage) 7
5 Ectopicpregnancy 8
6 Evacuationofretainedproductsofconception 10
7 Incidentalsurgeryinthepregnantpatient 12
8 Intrauterinesurgery 14
9 Terminationofpregnancy 16
II Normalpregnancyanddelivery 18
10 Anatomyofthespineandperipheralnerves 18
11 Physiologyofpregnancy 27
12 Aortocavalcompression 31
13 Normallabour 33
14 Gastric function and feeding in labour 35
15 Drugsandpregnancy 37
16 Placentaltransferofdrugs 39
vi Contents
17 Prescriptionandadministrationofdrugsbymidwives 42
18 Localanaesthetics 44
19 Antenatalfetalmonitoring 46
20 Chartingoflabour 48
21 Intrapartumfetalmonitoring 51
22 Painoflabour 54
23 Epiduralanalgesiaforlabour 56
24 Epiduraltestdoses 60
25 Combinedspinal-epiduralanalgesiaandanaesthesia 63
26 Spinalanalgesia 67
27 Caudalanalgesia 69
28 Spinalandepiduralopioids 69
29 Inhalationalanalgesicdrugs 72
30 Systemicanalgesicdrugs 74
31 Non-pharmacologicalanalgesia 77
III Operativedeliveryandthirdstage 80
32 Instrumentaldelivery 80
33 Caesareansection 82
34 EpiduralanaesthesiaforCaesareansection 86
35 SpinalanaesthesiaforCaesareansection 90
36 GeneralanaesthesiaforCaesareansection 94
37 Cricoidpressure 98
38 Failedanddifficultintubation 99
39 Awakeintubation 103
40 Post-Caesareansectionanalgesia 104
41 Removalofretainedplacenta 107
IV Anaestheticcomplications 110
42 Bloodytap 110
43 Duralpuncture 111
Contents vii
44 Postduralpunctureheadache 114
45 Epiduralbloodpatch 116
46 Extensiveregionalblocks 118
47 Inadequateregionalanalgesiainlabour 122
48 Backache 124
49 Horner’ssyndromeandcranialnervepalsy 126
50 Peripheralnervelesionsfollowingregionalanaesthesia 128
51 Spinalcordlesionsfollowingregionalanaesthesia 130
52 Arachnoiditis 132
53 Caudaequinasyndrome 134
54 Opioid-inducedpruritus 135
55 Shivering 136
56 Aspirationofgastriccontents 138
57 Awareness 141
58 Airembolism 144
V Problemsconfinedtoobstetrics 147
59 Inductionandaugmentationoflabour 147
60 Oxytocicandtocolyticdrugs 149
61 Prematurelabour,deliveryandruptureofmembranes 152
62 Malpresentationsandmalpositions 154
63 Externalcephalicversion 156
64 Multiplepregnancy 157
65 Trialofscar 159
66 Under-agepregnancyandadvancedmaternalage 161
67 Placentapraevia 162
68 Placentalabruption 165
69 Prolapsedcord 166
70 Fetaldistress 168
71 Intrauterinedeath 170
72 Uterineinversion 172
viii Contents
73 Majorobstetrichaemorrhage 173
74 Postpartumhaemorrhage 176
75 Collapseonlabourward 179
76 Maternalcardiopulmonaryresuscitation 180
77 Amnioticfluidembolism 182
78 Cholestasisofpregnancy(obstetriccholestasis) 183
79 Acutefattyliverofpregnancy 185
80 HELLPsyndrome 187
81 Hypertension,pre-eclampsiaandeclampsia 189
82 Magnesiumsulphate 196
83 Hyperemesisgravidarum 198
84 Maternalmortality 201
VI Problemsnotconfinedtoobstetrics 204
85 Allergicreactions 204
86 Cardiovasculardisease 206
87 Arrhythmias 210
88 Pulmonaryoedema 212
89 Cardiomyopathy 213
90 Coarctationoftheaorta 216
91 Prostheticheartvalves 218
92 Congenitalheartdisease 220
93 PulmonaryhypertensionandEisenmenger’ssyndrome 223
94 Ischaemicheartdisease 226
95 Endocrinedisease 228
96 Diabetesmellitus 229
97 Anaemiaandpolycythaemia 232
98 Deep-veinthrombosisandpulmonaryembolism 234
99 Thrombophilia 237
100 Coagulopathy 240