Handbook of Obstetric Anesthesia

Craig M. Palmer, Robert D'Angelo and Michael J. Paech

• 1. OVERVIEW OF OBSTETRIC ANESTHESIA (C.M. Palmer) 1.1 Introduction 1.2 A Brief History of Obstetric anesthesia 2. ANATOMIC AND PHYSIOLOGIC CHANGES OF PREGNANCY (L.S. Dean and R. D'Angelo) 2.1 Introduction 2.2 Cardiovascular 2.3 Pulmonary 2.4 Gastrointestinal 2.5 Renal 2.6 Hepatic 2.7 Gallbladder 2.8 Glucose Metabolism 2.9 Thyroid 2.10 Hematologic 2.11 Neurologic 2.12 Uterus 2.13 Skeletal 2.14 Summary 3. FETAL ASSESSMENT (C.M. Palmer) 3.1 Introduction 3.2 Normal Fetal Growth and Development 3.3 Utero-placental Physiology 3.4 Fetal Circulation 3.5 Prepartum Fetal Assessment 3.6 Intrapartum Fetal Heart Monitoring 3.7 In-utero Resuscitation 4. NEUROANATOMY AND NEUROPHARMACOLOGY (C.M. Palmer) 4.1 Introduction 4.2 Neuroanatomy 4.3 Neuropharmacology 4.4 Conclusions 5. REGIONAL ANALGESIA IN OBSTETRICS (R. D'Angelo and J.A. Thomas) 5.1 Introduction 5.2 Epidural Analgesia 5.3 Combined Spinal Epidural (CSE) Analgesia 5.4 Continuous Spinal Analgesia 5.5 Anesthesia for Vaginal Delivery 5.6 Alternative Regional Anesthetic Techniques 5.7 Improving Anesthetic Efficiency in Obstetrics 5.8 Epidural Analgesia and the Progress of Labor 6. ALTERNATIVE METHODS OF LABOR ANALGESIA (M.J. Paech) 6.1 Introduction 6.2 Preparation for Childbirth Pain 6.3 Specific Alternative Methods of Labor Analgesia 7. ANESTHESIA FOR CESAREAN SECTION (M.J. Paech) 7.1 History and Indications for Cesarean Section 7.2 Trends in Anesthetic Technique for Cesarean Section 7.3 Preparation of the Patient for Cesarean Section 7.4 Spinal Anesthesia for Cesarean Section 7.5 Epidural Anesthesia for Cesarean Section 7.6 Combined Spinal-Epidural Anesthesia (CSEA) 7.7 Continuous Spinal Anesthesia 7.8 Failure of Regional Anesthesia 7.9 General Anesthesia for Cesarean Section 8. POSTOPERATIVE ANALGESIA (C.M. Palmer) 8.1 Introduction 8.2 Epidural Morphine 8.3 Other Epidural Opioids 8.4 Nonopioid Analgesics 8.5 Summary of Epidural Analgesics 8.6 Intrathecal Morphine 8.7 Other Intrathecal Opioids 8.8 Continuous Intrathecal Analgesia 8.9 Patient-controlled Analgesia (PCA) 8.10 Nonsteroidal Agents (NSAIDs) 8.11 Conclusion 9. PREGNANCY INDUCED HYPERTENSION AND PREECLAMPSIA (K.E. Nelson and R. D'Angelo) 9.1 Introduction 9.2 Pathophysiology 9.3 Complications 9.4 Obstetric Management 9.5 Anesthetic Management 9.6 Anesthetic Options 9.7 Summary 10. HEMORRHAGE IN OBSTETRICS (C.M. Palmer) 10.1 Introduction 10.2 Uteroplacental Anatomy and Normal Delivery 10.3 Maternal Hemorrhage: Prepartum 10.4 Maternal Hemorrhage: Intrapartum 10.5 Maternal Hemorrhage: Postpartum 10.6 Uterotonics 10.7 Transfusion in Obstetrics 11. OBESITY (M. Owen and R. D'Angleo) 11.1 Introduction 11.2 Pathophysiology 11.3 Pregnancy and Obesity 11.4 Obstetric Complications 11.5 Fetal Complications 11.6 Anesthetic Considerations 11.7 Analgesia for Labor and Delivery 11.8 Anesthesia for Cesarean Section 11.9 Summary 12. COMPLICATIONS OF LABOR (C.M. Palmer) 12.1 Introduction 12.2 Prematurity and Preterm Labor 12.3 Multiple Gestation 12.4 Abnormal Presentation 12.5 Summary 13. COEXISTING DISEASE (M.J. Paech, C.M. Palmer, L.S. Dean and R. D'Angelo) 13.1 Introduction 13.2 Diabetes 13.3 Cardiac Disease 13.4 Pulmonary Disease 13.5 Neurologic and Neuromuscular Disease 14. NONANESTHETIC DRUGS AND OBSTETRIC ANESTHESIA (M.J. Paech) 14.1 Magnesium 14.2 Vasopressors 15. COMPLICATIONS OF OBSTETRIC ANESTHESIA AND ANALGESIA (M.J. Paech) 15.1 Post-dural Puncture Headache 15.2 Back Pain 15.3 Infection 15.4 Epidural and Subdural Hematoma 15.5 Neurological Deficit 15.6 High Regional Block 15.7 Intravenous Injection of Local Anesthetic 15.8 Complications of General Anesthesia 15.9 Medicolegal Considerations 16. NEONATAL RESUSCITATION (V. Arkoosh) 16.1 Introduction 16.2 Neonatal Adaptation to Extrauterine Life 16.3 Requirements for Effective Neonatal Resuscitation 16.4 Antepartum Assessment of Risk 16.5 Essentials of Neonatal Resuscitation 1