Anaesthesia for Obstetrics and Gynaecology

This newest contribution to the FAAM sequence offers a accomplished and recent dialogue of anaesthetic administration in being pregnant, in the course of supply, and in sufferers present process gynaecological surgical procedure. With authoritative contributions from overseas specialists it's a useful reference for all anaesthetists and expert clinicians.

Chapter 1 Maternal alterations in being pregnant (pages 1–29): James Eldrtdge
Chapter 2 the results of Anaesthesia and Analgesia at the child (pages 30–78): Jackie Porter
Chapter three ache reduction in Labour: Non?Regional (pages 79–108): Mark Scrutton
Chapter four neighborhood Analgesia and Anaesthesia (pages 109–177): Michael Paech
Chapter five normal Anaesthesia for Obstetrics (pages 178–200): Richard Vanner
Chapter 6 The Parturient with Co?Existing illness (pages 201–238): Philippa Groves and Michael Avidan
Chapter 7 clinical Emergencies in being pregnant (pages 239–280): Caroline Grange
Chapter eight Postnatal evaluation (pages 281–302): Robin Russell
Chapter nine Anaesthesia for Gynaecological surgical procedure (pages 303–345): Kym Osborn and Scott Simmons

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T h e most common surgical procedure in the first trimester is laparoscopy but cervical cerclage is also common in the latter part of the first and early in the second trimester. Even when the initial expectation is that fetal loss is inevitable, anaesthesia should be performed with the assumption that the fetus will survive. T o reduce the risks of teratogenicity and fetal loss, semiurgent surgery should be delayed from the first to the second trimester whenever possible. There are insufficient data to conclude whether regional or general anaesthesia is the safer option for either mother or fetus.

Prolonged use of nitrous oxide in adults has resulted in bone marrow depression, megaloblastic anaemia, and a demyelinating condition resembling subacute combined degeneration of the cord usually seen in patients with vitamin B,, deficiency. T h e doses received during labour or general anaesthesia for delivery are much less and there is no evidence to suggest that either parturients or neonates are at risk from these effects. 37 ANAESTHESIA FOR OBSTKI'RICS AND GYNABCOLOGY Nitrous oxide may increase the incidence of maternal hypoxia in labour although the relevance of this to fetal and neonatal welfare is unclear.

More important in maintaining the concentration gradient for these drugs, however, is the rate at which the drug is removed on the fetal side which depends, therefore, on the umbilical venous blood flow. These drugs are said to exhibit “flow-limited transfer” and include lignocaine and pethidine. A reduction in perfusion on either side of the placenta will slow transfer of these drugs. Plasma protein binding Most drugs are bound to plasma proteins; the more lipophilic the drug, the greater the degree of binding and it is only the unbound, free fraction that can cross the placenta.

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