Escolar Documentos
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Obstetric
Anesthesia
Elizabeth Wong, CRNA, MSN
LEARNING OBJECTIVES
Statistics
Epidural and Spinal use during
Labor:
4,130,665 births
1,686,213 parturients requested
epidural, spinal, or combined CSE
1,353,572 parturients had a c-section
(most common surgical procedure in
www.cdc.gov
8954 claims
Close Claim Analysis: Metzner et al. 2011 Best Practice and Research Clinical Anesthesiology.
1990-2003
MacRae, M. D., Closed Claim Studies in Anesthesia: A literature review and implications for practice. AANA Journal. 2007.
www.aana.com
#2 - Sleep Deprivation
Sleep Deprivation
Effect of work hour reduction on residents live: A
What to do?
Get a good nights sleep before your 24 hour shift
If awakened in middle of the night:
image:: www.stessily.hubpages.com
Labor epidural anesthetics comparing loss of resistance with air versus saline: Does the choice matter. Norman et al. 2006 AANA Journal
LOR...
Failed epidural top-up for cesarean delivery for failure to progress in labor: the plan is to do a single shot spinal. Carvalho. International journal of obstetric anesthesia. 2011.
#6 - Post-Dural Puncture
Headache (syndrome)
First description of PDPH is 100 years ago by Bier
Kuczkowski, KM. Post-dural puncture heardache in the obstetric patient: an old problem. New solutions. Minerva Anesthesiology. 2004.
Differential
Nonspecific headache
Caffeine-withdrawal headache
Migraine
Meningitis
Sinus Headache
Pre-eclampsia
Drug withdrawal (amphetamines, cocaine)
Pneumocephalus-related headache
Intracrainial pathology (hemorrhage, venous thrombosis)
Treatment
Theophylline
Caffeine (PO or IV)
Sumatriptan
Epidural saline
Epidural dextran
image: www..thelaughingstork.com
#8 - Bleeding Disorders
Hemophilia
image:.www.haemophelia.org.nz
Anticoagulated patients
Choi, S., Brull, R., Neuraxial Techniques in Obstetric and Non-obstetric Patients with Common Bleeding Disorders. Regional Anesthesia. 2009.
Green, L., Machin SJ. Managing anticoagulated patients during neuraxial aneesthesia. British Journal of Haematology. 2010.
Coagulopathic - Risks
vsn Veen et al. The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals. British Journal of Haematology. 2009.
Choi, S. Neuraxial techniques in obstetric and nonobstetric patients with common bleeding diatheses. Regional Anesthesia. 2009.
Green et al. Managing anticoagulated patients during neuraxial aneaesthesia. British Journal of Haematology. 2010
#9 - Hemorrhage
Uterine Rupture
Vaginal birth after c-section
Repeat c-section
Placenta previa, accreta, or percreta
image:www.najms.org
Coagulopaties
Hepner, DL., Gutsche, BB. Obstetric Hemmorrhage. Current Reviews for Nurse Anesthetists. 1998.
Ridgeway, J., Weyrich DL., Benedetti, TJ. Fetal Heart rate changes associated with uterine rupture. American College of Obtetricians and Gynecolotgists. 2004.
California
California Maternal Quality Care
Collaborative (www.cmqcc.org)
California - ~550,000 annual births -
image:www.sciencephotobibrary.com
image:www.pie.med.utoronot.ca
Questions?