Obstetric Anesthesia

440 Pages·2011·2.23 MB·English

Obstetric
Anesthesia
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Obstetric
Anesthesia
Craig M. Palmer, MD
Professor of Anesthesiology
University of Arizona
Tucson, Arizona
Robert D’Angelo, MD
Professor, Obstetric and Gynecologic Anesthesia
Wake Forest University School of Medicine
Winston-Salem, North Carolina
Michael J. Paech, FANZCA
Winthrop Professor and Chair of Obstetric Anaesthesia
School of Medicine and Pharmacology
The University of Western Australia
Perth, Australia
1
1
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Palmer, Craig M., author.
Obstetric anesthesia / Craig M. Palmer, Robert D'Angelo, Michael J. Paech
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-19-973380-4
1. Anesthesia in obstetrics. 2. Analgesia. I. D'Angelo, Robert, author.
II. Paech, Michael J., author. III. Title.
[DNLM: 1. Anesthesia, Obstetrical. 2. Analgesia, Obstetrical. 3. Gynecologic Surgical
Procedures—methods. WO 450]
RG732.P36 2011
617.9'682—dc22
2010050965
This material is not intended to be, and should not be considered, a substitute for medical or
other professional advice. Treatment for the conditions described in this material is highly
dependent on the individual circumstances. And, while this material is designed to offer accurate
information with respect to the subject matter covered and to be current as of the time it was
written, research and knowledge about medical and health issues is constantly evolving and dose
schedules for medications are being revised continually, with new side effects recognized and
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procedures with the most up-to-date published product information and data sheets provided by
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authors make no representations or warranties as to the accuracy or effi cacy of the drug dosages
mentioned in the material. The authors and the publisher do not accept, and expressly disclaim,
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of the use and/or application of any of the contents of this material.
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
C Coonntteennttss
Preface vviiii
Contributors iixx
Abbreviations xxii
1. Neuroanatomy and Neurophysiology 1
2. Anatomic and Physiologic Changes of Pregnancy 19
3. Pain Relief for Labor and Delivery 31
4. Anesthesia for Cesarean Delivery 79
5. Post-Cesarean Analgesia 156
6. Anesthesia for Surgery During and After Pregnancy 182
7. Pregnancy Induced Hypertension and Preeclampsia 199
8. Obstetric Hemorrhage 213
9. Obesity 242
10. Coexisting Disease and Other Issues 265
11. Complications of Labor and Delivery 314
12. Fetal Assessment and Care 342
13. Management of Later Complications of
Obstetric Anesthesia and Analgesia 361
14. Critical Care of the Obstetric Patient 392
15. Neonatal Resuscitation 402
Index 441155
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Preface
Obstetric anesthesia is a rapidly expanding, constantly evolving fi eld;
some years ago we saw a need for a practical guide to patient care and
management—one that could be consulted quickly (and often) to
outline a concrete course of clinical management, covering how to
manage specifi c patients in specifi c situations. What drug to give, how
to give it, how much to give, and when to stop and try something
different. Our goal has been to provide anesthesiologists and anes-
thetists, both in training and in practice, with that practical reference.
Our fi rst attempt to provide such a reference met many of these
objectives, but in one area fell far below our vision. In 2002 we pub-
lished the H andbook of Obstetric Anesthesia with a different publisher, vii
who had their own vision for the text, and while the information and
style of the Handbook were what we envisioned, its physical form was
not. Rather than being a pocket-sized, inexpensive, “ready reference,”
it was a larger, hardcover text. While visually appealing, it was more at
home on a bookshelf than in the pocket of a scrub suit or on an
anesthesia cart.
With our new partnership with Oxford University Press, we have at
last achieved what we set out to do 10 years ago. We have worked
diligently to make the information easy to use—when possible, we
have tried to distill essential information into tables, charts, diagrams,
and fl owcharts that can be quickly accessed and applied. We have
used bullet points to highlight key points of management, and the
essential background, rationale, and science behind clinical decision
making. This is not intended to be an exhaustive reference textbook,
although the readings and references at the end of each chapter do
provide additional background and the basis for further study.
Of course, there is usually more than one means to an end, but
where our experience has shown one approach works best, we’ve
advocated it. Where there are equally viable options, we’ve tried to
present each, with the advantages and disadvantages of alternative
approaches.
E
C All three of us have dedicated our careers to the anesthetic care
A
EF of obstetric patients, as have our contributors. We care for these
R
P patients and deal with these problems every day. O bstetric Anesthesia
draws on our experience and study to tell you what we do, how we
do it, and why.
Craig M. Palmer, MD
Robert D’Angelo, MD
Michael J. Paech, FANZCA
viii
Contributors
Valerie A. Arkoosh, MD, MPH
Professor of Clinical Anesthesiology and Critical Care
Professor of Clinical Obstetrics and Gynecology
University of Pennsylvania School of Medicine
Philadelphia, PA
Emily Baird, MD, PhD
Assistant Professor of Clinical Anesthesiology and Critical Care
University of Pennsylvania School of Medicine
Philadelphia, PA
Laura S. Dean, MD x
i
Assistant Professor, Obstetric & Gynecologic Anesthesia
Wake Forest University School of Medicine
Winston-Salem, NC
Kenneth E. Nelson, MD
Associate Professor, Obstetric & Gynecologic Anesthesia
Wake Forest University School of Medicine
Winston-Salem, NC
Medge D. Owen, MD
Professor, Obstetric & Gynecologic Anesthesia
Wake Forest University School of Medicine
Winston-Salem, NC
John A. Thomas, MD
Associate Professor, Obstetric & Gynecologic Anesthesia
Wake Forest University School of Medicine
Winston-Salem, NC