Anesthesia Student Survival Guide.pdf - Index of

PhysiOlOGy And AnesthesiA FOr OBstetriCs ● 315
may help to distinguish obstetric trauma from block needle trauma. A deficit
is more likely due to obstetric trauma if it corresponds to the distribution of
a peripheral nerve, whereas a dermatomal distribution may be more likely the
result of a neuraxial block.
Though often debated, it is not clear whether or not epidural analgesia
prolongs labor. Epidural analgesia was historically avoided in early labor for
fear of prolonging it. Fortunately for laboring women, this practice has been
largely abandoned.
Anesthesia for Cesarean Section
Cesarean section is most commonly performed under regional anesthesia.
Though rarely necessary, the operation can be performed under local
anesthesia. When choosing the anesthetic, one must consider a number of
factors, particularly indication for cesarean, case urgency, and maternal-fetal
well-being. Common indications for cesarean section include fetal distress,
risk of maternal hemorrhage, dystocia (abnormal labor), and impending
maternal death.The qualities of an ideal anesthetic for cesarean section are
listed in Table 19.4. Neuraxial anesthesia, though not ideal, usually represents
the best option.
Table 19.4 Qualities of an ideal anesthetic for cesarean section.
efficacious and reliable
Can be achieved instantaneously
duration of action coincides with duration of surgery
Avoids aspiration of gastric contents
Avoids airway manipulation (negates the risk of difficult intubation)
Allows maternal participation in delivery
Conducive to family member presence in operating room
does not interfere with neonatal well-being
Allows for stable hemodynamics
does not interfere with hemostasis
no complications or unwanted side effects
no contraindications/no technical failures
Alleviates post-operative pain