Pharmacology, Physiology, and Practice in Obstetric Anesthesia

1st Edition - March 31, 2025
Imprint: Academic Press
Editors: Alan D. Kaye, Aaron J. Kaye
Language: English
Paperback ISBN:
9 7 8 - 0 - 4 4 3 - 2 1 7 0 7 - 4
eBook ISBN:
9 7 8 - 0 - 4 4 3 - 2 1 7 0 6 - 7

Pharmacology, Physiology, and Practice in Obstetric Anesthesia provides all the essentials of obstetric anesthesia in a straightforward, user-friendly format that avoids encyclope… Read more

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Pharmacology, Physiology, and Practice in Obstetric Anesthesia provides all the essentials of obstetric anesthesia in a straightforward, user-friendly format that avoids encyclopedic language and lengthy discussions, and is inclusive of other healthcare specialties and subspecialties including obstetrics, neonatal care, and more. Coverage spans the essentials of obstetrics as well as overlooked issues including obstetric pharmacology and physiology safe practice strategies, clinical concepts for vaginal delivery and C-section, high-risk pregnancy states and management of the complicated parturient, complications and medicolegal, fetus and newborn considerations, and guidelines, standards and statements related to obstetric anesthesia.

Pharmacology, Physiology, and Practice in Obstetric Anesthesia is the perfect reference for an interdisciplinary group of health professionals, policymakers, and researchers working and training in the field of obstetric anesthesiology

Title of Book
Cover image
Title page
Table of Contents
Copyright
Dedication
Contributors
About the editors
Preface
Section I. Obstetric pharmacology, physiology and safe practice strategies
Chapter 1. Physiological maternal adaptive changes during pregnancy, e.g., alterations of endometrium and decidua, menstruation, placenta, fetal membranes, placental hormones, morphological and functional fetal development
1 Introduction
2 Estrogen and progesterone in pregnancy
2.1 Progesterone
2.2 Estrogen
2.3 Decidualization
3 Physical changes in pregnancy
3.1 Cardiovascular system
3.2 GI system
3.3 Respiratory system
3.3.1 Metabolism
3.4 Skin
3.5 Sensory
3.6 Hematology
4 Pharmacologic changes in pregnancy
4.1 Absorption
4.2 Distribution
4.3 Metabolism
4.4 Elimination
5 Issues arising from the physiologic changes of pregnancy
5.1 Hypertensive disorders of pregnancy
5.1.1 Pathophysiology of preeclampsia
5.2 Peripartum cardiomyopathy
5.3 Pulmonary changes in pregnancy
5.4 Postpartum depression
6 Conclusion
Chapter 2. Anatomy of the reproductive tract: The placenta, uteroplacental circulation, anatomy, transfer of drugs, and respiratory gas exchange
1 Anatomy of the female reproductive tract
1.1 Organs
1.2 Innervation
1.3 Blood flow
1.4 Uterine blood flow changes during pregnancy
2 Anatomy of the placenta
2.1 Embryology
2.2 Macroscopic anatomy
2.3 Maternal vasculature
2.4 Fetoplacental vasculature
3 Placental physiology
3.1 Oxygen transfer
3.2 Carbon dioxide transfer
3.3 Acid base
3.4 Placental drug transfer
3.5 Common drugs used during pregnancy
3.6 Anesthetic drugs and placental transfer
4 Conclusion
Chapter 3. Uterine blood flow and the effects of obstetric anesthesia
1 Introduction
2 Anatomy
3 Uteroplacental blood flow
4 Response to vasoactive agents
5 Mechanisms of changes
6 Determinants of uterine blood flow
7 Measuring uterine blood flow
8 Regional anesthesia and uterine blood flow
9 Doppler ultrasonography and uterine blood flow
10 General anesthesia and uterine blood flow
11 Effects of obstetric drugs
12 Conclusion
Chapter 4. Perinatal pharmacology
1 Definition, background
2 Maternal factors
3 Placental factors
4 Basic fetal pathophysiology and risk factors
5 Fetal drug uptake, distribution, metabolism, and excretion
6 Related issues, historical trends
Chapter 5. Parturient anesthesia assessment and evaluation
1 Introduction
2 History of anesthesia in obstetrics
3 Physiological changes in pregnancy
3.1 Cardiovascular (ACOG Practice Bulletin No. 211, 2019; Guntupalli et al., 2015; Crozier, 2017; Kaur & Miller, 2017; Cutforth & MacDonald, 1966)
3.2 Respiratory (Leontic, 1977; Wise et al., 2006; ACOG Practice Bulletin No. 211, 2019; Guntupalli et al., 2015; Kaur & Miller, 2017; Chang & Streitman, 2012)
3.3 Gastrointestinal
3.4 Urinary (ACOG Practice Bulletin No. 211, 2019; Kaur & Miller, 2017; Guntupalli et al., 2015)
3.5 Endocrine
3.6 Hematologic
3.7 Coagulation
4 Preanesthesia evaluation of parturients (Practice Advisory for Preanesthesia Evaluation, 2012; Practice Guidelines for Obstetric Anesthesia, 2016)
4.1 Past surgical history and anesthetic history
4.2 Past obstetric history
4.3 Past medical history
4.4 Physical examination
5 Evaluation of parturient with systemic disease
5.1 Cardiovascular diseases
5.1.1 Congenital heart disease (Wei & Noel Bairey Merz, 2018)
5.1.2 Infective endocarditis
5.1.3 ICDs and pacemakers
5.1.4 Arrhythmias
5.1.5 Valvular heart diseases
5.1.6 Cardiomyopathies and heart failure
5.1.7 Pericarditis
5.2 Respiratory diseases
5.2.1 Asthma
5.2.2 Cystic fibrosis
5.3 Anemias
5.4 Coagulation disorders
5.4.1 von Willebrand Disease
5.4.2 Thrombocytopenia
5.4.3 Anticoagulants
6 Endocrine diseases
6.1 Diabetes mellitus
6.2 Hyperthyroidism
6.3 Musculoskeletal disorders
6.3.1 Lumbopelvic discomfort and chronic back pain
6.3.2 Scoliosis
6.3.3 Rheumatoid arthritis
6.3.4 Ankylosing spondylitis
6.4 Renal diseases
6.4.1 Chronic renal disease
6.4.2 Acute renal failure
6.5 Liver diseases
7 Conclusion
Chapter 6. How to create and maintain a safe and an efficient obstetric anesthesia practice
1 Introduction
2 Maternal care framework in the United States
3 Preanesthesia evaluation for obstetric patients
3.1 Background
4 Current state of affairs and challenges
4.1 Recommendations
5 Telemedicine
6 Patient education
7 Intrapartum care for parturient
7.1 Introduction
8 Challenges and recommendations
8.1 Medication shortages
8.2 Staffing and training/anesthesia workforce
8.2.1 Challenges
8.3 Recommendations
8.4 Anesthesia management of high-risk pregnancies
8.5 Peripartum obstetric hemorrhage
8.5.1 Challenges
8.5.2 Recommendations
8.6 Concept of the pregnancy heart team and cardiac obstetrics
8.6.1 Challenges
8.6.2 Recommendations
8.7 Critical care in obstetrics
9 Enhanced recovery after CD
10 Process improvement to enhance patient safety in obstetric anesthesia
11 Handoffs and checklists
12 Simulation and team working in obstetric anesthesia
13 Racial disparities
14 Strategies to improve global inequities in obstetric anesthesia
15 Trauma informed care in obstetrics
Section II. Clinical concepts of obstetrics and anesthesia for vaginal delivery and C-section
Chapter 7. Obstetric anesthesia consultation
1 Indications for consultation
2 Components of consultation
3 Common indications for anesthesiology consultation
3.1 Anticoagulation
4 Thrombocytopenia
5 Placenta accreta spectrum (PAS)
6 Maternal cardiovascular disease
6.1 Interventions/ECMO
7 Spinal column/cord pathology, neurologic disease
8 Obesity
9 Opioid use disorder (OUD)
10 History of anesthetic complications
11 Consultation clinics
12 Conclusion
Chapter 8. Obstetric management of labor and delivery, including preoperative assessment and basic standards for preanesthesia care
1 Introduction
2 CVD in the pregnant patient
3 Pregnancy counseling risk stratification
4 Mode and timing of delivery
5 Type of hospital and location within the hospital
6 Peripartum plan
7 The difficult airway in obstetrical anesthesia assessment
8 Preparation for difficult airway management
9 Difficult airway trolley
10 Difficult airway management
11 Simulation and training
12 Mental health and pregnancy
13 Management of psychiatric patients during pregnancy
14 Racial disparities in maternity care
15 Strategies for reducing disparities
15.1 Implementing protocols and safety bundles
16 Health care professionals' education and communication
17 Outcome measurement, reviews, and community partnerships
18 Neuroobstetrics
19 Antenatal period/preconception
20 Intrapartum
21 Postpartum
22 Multiple sclerosis
23 Cerebrovascular diseases in pregnancy
24 Role of anesthesiologist in the management of stroke
25 Headache during pregnancy and postpartum
26 Evaluation of pregnant patients with headaches (Headaches in Pregnancy and Postpartum, 2022)
27 Pregnancy and hematology
28 Iron-deficient anemia
29 Coagulation disorders
30 Hereditary coagulation disorders
31 Acquired coagulation disorders
32 Venous thromboembolism
32.1 Antepartum recommendations
32.2 Intrapartum recommendations
33 Respiratory diseases in pregnancy
34 Asthma
35 Respiratory failure
36 Obstructive sleep apnea
Chapter 9. Fetal assessment and physiology
1 Antenatal fetal assessment
2 Estimating gestational age
3 Routine ultrasonography
4 Evaluating the well-being of the fetus
4.1 Clinical assessment
5 Antepartum fetal testing
6 Fetal development and physiology
7 Fetal environment
8 Fetal cardiovascular system
9 Fetal respiratory system
10 Fetal hematologic system
11 Fetal neurologic system
12 Transition to the extrauterine environment
13 Physiologic changes in postnatal life
13.1 Cardiovascular and respiratory changes
14 Thermal regulation
15 Postnatal fetal assessment
16 APGAR score and umbilical cord gas and pH
Chapter 10. Opioid analgesics in labor
1 Introduction
2 Opioids
2.1 Mechanism of action
3 Pharmacokinetics
3.1 Absorption
3.2 Distribution
3.3 Biotransformation
3.4 Excretion
4 Effect on organ systems
4.1 Cardiovascular
4.2 Respiratory
4.3 Cerebral
4.4 Gastrointestinal
5 Plan for labor analgesia
6 Pharmacologic options for labor analgesia
7 Systemic analgesics
7.1 Opioid analgesia
8 Patient-controlled analgesia
8.1 Remifentanil PCA
8.2 Fentanyl PCA
8.3 Intermittent bolus opioid
8.4 Choice of opioid
8.4.1 Nalbuphine
8.5 Butorphanol
8.6 Fentanyl
8.7 Morphine
8.8 Meperidine
9 Regional analgesia
9.1 Neuraxial analgesia
9.2 Mechanism and site of action
9.3 Epidural opioids
9.4 Intrathecal opioids
10 Summary and conclusion
Chapter 11. Mechanisms of labor pain and anesthesia in healthy parturients
1 Mechanisms of labor pain and its management
2 Nonpharmacologic treatment of pain
3 Pharmacologic techniques for labor pain control
3.1 Inhaled agents
3.2 Opioids
3.3 Neuraxial techniques
Chapter 12. Nonopioid analgesia
1 Nitrous oxide
2 Acetaminophen and nonsteroidal antiinflammatory drugs
3 Sedatives and analgesic adjuncts
Chapter 13. Nonpharmacologic and alternative management of labor and delivery analgesia
1 Introduction
2 Water immersion
3 Biofeedback
4 Hypnosis
5 Acupuncture
6 Subcutaneous of intracutaneous sterile water injection
7 Manual/massage/reflexology
8 Conclusion
Chapter 14. Local anesthetics and adjuvants in healthy obstetric patients
1 Introduction
2 Lidocaine
2.1 Mechanism of action
2.2 Clinical application
2.3 Side-effect profile
3 Ropivacaine
3.1 Mechanism of action
3.2 Clinical application
3.3 Side-effect profile
4 Bupivacaine
4.1 Mechanism of action
4.2 Clinical application
4.3 Side-effect profile
5 Chloroprocaine
5.1 Clinical application
5.2 Side-effect profile
6 Mepivacaine
6.1 Clinical application
6.2 Side-effect profile
7 Local anesthetic systemic toxicity
8 Adjuncts in neuraxial anesthesia
9 Epinephrine
10 Bicarbonate
11 Clonidine
12 Dexmedetomidine
13 Neostigmine
14 Magnesium
15 Experimental adjuncts
16 Opioids
17 Conclusion
Chapter 15. Epidural anatomy and epidural anesthesia for labor and cesarean delivery
1 Introduction
2 Background
2.1 Epidural analgesia for labor and vaginal delivery
2.2 Epidurals for CD
3 Definition of topic
4 Issues related to this topic
5 Historical evolution/trends
6 Pathophysiology
6.1 Anatomy of the epidural space
7 Risk factors
8 Patient evaluation
9 Diagnosis
9.1 Medical History
9.2 Coagulation Status
9.3 Infection Control
9.4 Anatomical Considerations
9.5 Patient Preference and Informed Consent
9.6 Multidisciplinary Collaboration
10 Treatment
11 Anesthetic management
12 Pharmacology
13 Clinical issues or considerations
14 Prevention and self-care
15 Global impact and challenges
16 Future directions, novel treatments, and research studies
17 Summary/conclusion
18 Relevant images and tables
Abbreviations
Chapter 16. Neuraxial anesthesia for vaginal delivery
1 Introduction
2 Historical evolution/trends
3 Pathophysiology and anatomy
3.1 Anatomy
3.2 Pathophysiology
4 Equipment and anesthetic management/pharmacology
5 Patient evaluation
5.1 Indications and contraindications
6 Risk and complications
6.1 Hypotension
6.2 Fever
6.3 Dural puncture headache
6.4 Local anesthetic systemic toxicity
7 Recent clinical studies
8 Summary and conclusions
Chapter 17. Neuraxial analgesia for cesarean delivery
1 Background
1.1 Cesarean delivery
1.2 Anesthesia with cesarean delivery
1.3 Trends in cesarean sections
2 The cesarean delivery
2.1 Indications
2.2 Contraindications
2.3 Degree of urgency
2.4 Risks
3 Anesthetic considerations for cesarean delivery: General anesthesia
3.1 Airway
3.2 Volatile anesthetics
3.3 Anterograde amnesia
4 Anesthetic considerations for the cesarean delivery: Neuraxial approach
4.1 Spinal
4.2 Epidural
4.3 Combined spinal and epidural
5 Acquiring the neuraxial blockade
5.1 Anatomic landmarks
5.2 Epidural placement
5.2.1 Layers traversed
5.3 Procedural steps
5.4 Spinal placement
5.4.1 Layers traversed
5.5 Procedural steps
5.6 Combine spinal–epidural placement
5.6.1 Layers traversed
5.7 Procedural steps
5.8 Settings of placement
6 Diagnosing the coverage of neuraxial anesthesia
6.1 Appropriate coverage
6.2 Assessment using pinprick or temperature sensation
7 Troubleshooting inadequate coverage of neuraxial analgesia
7.1 Epidural management
7.2 Spinal management
8 Side effects of effective neuraxial block
8.1 Hypotension
8.2 Nausea
8.3 Shivering
9 The awake patient
9.1 Communication with parturient
9.2 Communication with other members of the medical team
9.3 Patient positioning
10 Global impact and challenges
11 Future directions, novel treatments, or research studies
Chapter 18. General anesthesia for normal, uncomplicated cesarean delivery: Indications and strategies
1 Introduction
2 Background
3 Definition of the topic
3.1 General anesthesia
3.2 Cesarean delivery
4 Issues related to GA for the CD
4.1 Potential risks and side effects
4.2 Choice of anesthetic agents
4.3 RA versus GA
5 Historical evolution/trends
5.1 Early developments
5.2 Advent of RA
5.3 Shift from GA to RA
5.4 Current practices
6 Pathophysiology
6.1 Nervous system
6.2 Maternal physiology
6.3 Fetal physiology
6.4 Postoperative recovery
7 Risk factors
7.1 Maternal health conditions
7.2 Obstetric complications
7.3 Fetal health concerns
7.4 Specific perioperative risks
8 Patient evaluation
8.1 History taking
8.2 Physical examination
8.3 Relevant investigations
9 Diagnosis
10 Treatment
10.1 Preoperative preparation
10.2 Preoxygenation and preinduction
10.3 Induction and intubation
10.4 Maintenance and emergence
10.5 Postoperative care
11 Anesthetic management
11.1 Preoperative preparation
11.2 Intraoperative management
11.3 Postoperative management
12 Pharmacology
13 Clinical issues or considerations
13.1 Urgent versus elective CD
13.2 Patient preference
13.3 General health status
14 Prevention and self-care
15 Global impact and challenges
16 Future directions, novel treatments, and research studies
16.1 Improved monitoring techniques
16.2 Novel anesthetic agents
16.3 Enhanced recovery after surgery protocols
16.4 Telemedicine and digital health
16.5 Research on long-term impacts
17 Summary and conclusion
Abbreviations
Chapter 19. Airway management of the pregnant patient for labor and cesarean delivery
1 Incidence of GA and difficult airways in the obstetric population
2 Physiological changes during pregnancy: Implications on airway management22–27
2.1 Respiratory parameters and gas exchange alterations
2.1.1 Increase in tidal volume and respiratory rate
2.1.2 Decreased functional residual capacity
2.1.3 Changes in oxygen and carbon dioxide levels
2.1.4 Clinical implications: Rapid desaturation in pregnant women
2.2 Airway obstruction and difficulty in intubation
2.2.1 Capillary engorgement and tissue swelling
2.2.2 Mallampati class, laryngoscopy, and intubation difficulty prediction
2.3 Gastric emptying and aspiration risk
2.4 Pharmacological considerations
3 Evaluation and prediction of difficult airway
4 Maternal complications related to airway management
4.1 Aspiration pneumonitis
4.2 Bronchospasm
4.3 Post-extubation hypoventilation
4.4 Accidental awareness
5 Suggested protocol for airway management in pregnant women
5.1 Preparation of the parturient
5.2 Preparation of equipment and personnel
5.3 Positioning
5.4 Preoxygenation/apneic oxygenation
5.5 Rapid sequence induction
5.6 Induction and neuromuscular drugs
5.7 Cricoid pressure
5.8 Laryngoscopes
5.9 Tracheal extubation
6 Guidelines for difficult airway in pregnant women (UK-OAA/DAS)
6.1 Anticipated difficult intubation
6.2 Unanticipated difficult or failed intubation
6.3 Direct and indirect (video) laryngoscopy direct laryngoscopy
6.4 Obstetric Anesthetists' Association and Difficult Airway Society guidelines
6.5 Other relative guidelines
Chapter 20. Postoperative pain management for cesarean delivery
1 Acute pain after cesarean delivery
2 Neuraxial anesthesia and adjuvant drugs
2.1 Multimodal analgesia
2.2 Shared decision-making for pain management in the postpartum period
2.3 Opioid-sparing multimodal analgesia (OSMMA)
2.3.1 Nonsteroidal anti-inflammatory drugs and acetaminophen and others
3 Opioid analgesics
4 Enhanced Recovery After Cesarean (ERAC)
4.1 Racial and ethnic disparities
5 General anesthesia
6 Local and regional analgesia techniques
7 Acute pain management for the patient with substance use disorder (SUD)
Chapter 21. Postoperative sterilization surgery and anesthesia considerations
1 Introduction: Postpartum birth control
1.1 The advantages of postpartum birth control preplanning
2 Methods for immediate postpartum contraception
2.1 Reversible contraception
2.2 Irreversible contraception
3 Current policies affecting postpartum sterilization
4 Postpartum sterilization procedure
4.1 Surgical considerations
4.2 Anesthetic considerations
5 Postsurgical sterilization pain management
6 Chapter summary
Chapter 22. Anesthesia for assisted reproductive techniques
1 Introduction
1.1 What is assisted fertilization
1.2 Ovum retrieval done through
1.3 Sperm collection
1.4 Patient preparation
1.5 Does ART procedure need anesthesia?
1.6 Conscious sedation
2 General anesthesia
2.1 Propofol
2.2 Thiopental
2.3 Ketamine
2.4 Etomidate
2.5 Inhalational anesthesia
2.6 Benzodiazepine
2.7 Dexmedetomidine
2.8 Opioids
2.9 Non-opioid analgesic
2.10 Antiemetics
2.11 Neuraxial anesthesia
2.12 Paracervical block
2.13 Patient controlled analgesia
2.14 Newer techniques
2.15 Complications associated with assisted fertilization
2.16 Ovarian hyperstimulation syndrome
2.17 Ectopic pregnancy
2.18 Multiple gestation
Section III. High-risk pregnancy states: Evaluation and management of the complicated parturient
Chapter 23. Anesthesia considerations for pregnant patients with cardiovascular disease
1 Cardiac diseases in pregnancy
2 Common risk factors of cardiac disease in pregnancy
3 Types of cardiac diseases in pregnancy
4 Risk classification of the patient with cardiac diseases
5 General considerations of cardiac parturients
6 Preoperative evaluation of cardiac pregnant patient
7 History
8 Preoperative clinical assessment
8.1 Cardiac tests during pregnancy
9 Preoperative considerations for specific cardiac lesions
9.1 Congenital heart diseases
9.2 Arrhythmia
9.3 Prosthetic heart valves
10 Rheumatic valvular disease
10.1 Mitral stenosis (MS)
10.2 Mitral or aortic regurgitation
10.3 Myocardial infarction
10.3.1 The risk factors are
10.3.2 Preoperative test for ischemic heart diseases
10.3.3 Management of acute coronary syndrome
11 Peripartum cardiomyopathy
11.1 Cardiac tests for diagnosis of peripartum cardiomyopathy
11.1.1 Management of peripartum cardiomyopathy
12 Preoperative preparation of cesarean section
12.1 Monitoring for cesarean delivery
13 Anesthesia techniques
13.1 Regional anesthesia
14 Anticoagulant therapy considerations
14.1 The cardiovascular effects of regional anesthesia (Fig. 23.3)
14.2 The type and severity of cardiac illness
14.3 How to conduct safe neuraxial anesthesia
15 Postpartum care
16 Conclusion
Chapter 24. Anesthesia considerations for pregnant patients with lung disease
1 Introduction
2 Background
3 Issues related to this topic
4 Historical evolution/trends
5 Pathophysiology
6 Risk factors
6.1 Preexistent pulmonary disease
6.1.1 Restrictive lung disease
6.1.2 Obstructive lung disease
6.2 Acquired pulmonary disease
6.2.1 Respiratory tract infections
6.2.2 Cesarean delivery
6.2.3 Hypertensive disease of pregnancy
6.2.4 Obstetric complications
6.2.5 Gastroesophageal reflux disease
7 Patient evaluation
7.1 History
7.2 Physical
7.3 Confirmatory tests
8 Diagnosis
8.1 Obstructive lung disease
8.2 Restrictive lung disease
8.3 Respiratory tract infections
8.4 ARDS
9 Treatment
9.1 Asthma
9.2 Cystic fibrosis
9.2.1 Restrictive lung disease
9.2.2 Obstructive sleep apnea
9.2.3 Smoking during pregnancy
9.2.4 Respiratory tract infections
9.2.5 ARDS
10 Anesthetic management
10.1 General principles
10.1.1 Asthma
10.1.2 Restrictive lung disease
10.1.3 Obstructive sleep apnea
10.1.4 Smoking during pregnancy
10.1.5 Pulmonary hypertension
10.1.6 Respiratory tract infections
11 Global impact and challenges
12 Future directions, novel treatments, or research studies
13 Summary and conclusion
Chapter 25. Anesthesia considerations for patients with renal, hematologic, connective tissue, and immunologic diseases
1 Introduction
2 Renal considerations
2.1 Definition, background, related issues, historical trends
2.2 Pathophysiology
2.3 Risk factors
2.4 Patient evaluation, diagnosis, treatment
2.5 Anesthetic management, pharmacology
3 Hematologic considerations
3.1 Definition, background, related issues, historical trends
3.2 Pathophysiology
3.3 Risk factors
3.4 Patient evaluation, diagnosis, treatment
3.5 Anesthetic management, pharmacology
3.6 Clinical issues/considerations, prevention, self-care
3.7 Global impact and challenges
4 Connective tissue considerations
4.1 Definition, background, related issues, historical trends
4.2 Pathophysiology
4.3 Anesthetic management and risk management
4.4 Patient evaluation, clinical issues/considerations, prevention
5 Immunologic considerations
5.1 Definition, background, related issues, historical trends
5.2 Pathophysiology
5.3 Risk factors
5.4 Patient evaluation, diagnosis, treatment
5.5 Anesthetic management, pharmacology
5.6 Clinical issues/considerations, prevention, self-care
5.7 Global impact and challenges
6 Future directions, novel treatments, or research studies
7 Summary and conclusion
Chapter 26. Anesthesia considerations for parturients with endocrine disorders
1 Introduction
2 Diabetes mellitus
2.1 Anesthetic implications
3 Thyroid disease
3.1 Hyperthyroidism
3.2 Hypothyroidism
3.3 Temperature regulation
4 Pituitary disease
4.1 Acromegaly
5 Adrenal disease
5.1 Cushing syndrome
5.2 Adrenocortical insufficiency
5.3 Pheochromocytoma
Chapter 27. Anesthetic considerations for patients with neurologic disorders in pregnancy
1 Introduction
2 Background
3 Case #1
3.1 Historical evolution/trends
3.2 Pathophysiology
3.3 Risk factors
3.4 Patient evaluation/diagnosis
3.5 Treatment/surgical correction
3.6 Impact on pregnancy
4 Case #2
4.1 Historical evolution/trends
4.2 Pathophysiology
4.3 Risk factors
4.4 Treatment
4.5 Impact of pregnancy
5 Case #3
5.1 Pathophysiology
5.2 Risk factors
5.3 Patient evaluation/diagnosis
5.4 Treatment
5.5 Impact on pregnancy
6 Case #4
6.1 Historical evolution/trends
6.2 Pathophysiology
6.3 Impact on pregnancy
7 Conclusion
Chapter 28. Anesthesia considerations for fetal growth restriction and macrosomia in pregnancy
1 Fetal macrosomia
2 Obstetric anesthesia considerations complicated by macrosomia and fetal growth restriction
2.1 Anesthesia considerations for a cesarean birth
2.2 Anesthesia considerations for conversion from vaginal to cesarean birth
2.3 Pregnancy complications related to fetal growth outcomes and anesthesia considerations
2.4 Intraoperative complications
2.5 Intraoperative complications associated with FGR
2.5.1 Hemodynamic instability
2.5.2 Altered pharmacokinetics
2.5.3 Emergency situations
2.6 Intraoperative complications associated with macrosomia
2.6.1 Difficult airway management
2.6.2 Neuraxial anesthesia challenges
2.6.3 Increased risk of operative delivery
3 Common intraoperative complications in both conditions
3.1 Blood loss and hemorrhage
3.2 Amniotic fluid embolism
3.3 Monitoring and management strategies
3.4 Fetal growth restriction: Definition, diagnosis, and anesthetic implications
3.5 Anesthetic considerations for FGR
3.6 Optimal timing for induction in FGR
3.7 Minimizing risks and enhancing safety
3.8 Anesthetic agent teratogenicity
Chapter 29. Anesthesia considerations for pregnant patients with morbid obesity and neoplasm
1 Introduction and background
1.1 Definition
2 Issues related to maternal obesity
3 Pathophysiology
3.1 Effect of obesity on the respiratory system
3.2 Effect of obesity on the cardiovascular system
3.3 Effect of obesity on the gastrointestinal system
4 Anesthetic management
4.1 Preoperative assessment
4.2 Preoperative counseling
4.3 Monitors and access
5 Labor analgesia
5.1 Equipment set up
5.2 Patient positioning
5.3 Epidural versus DPE versus CSE for labor analgesia
5.4 Epidural catheter dislodgement
5.5 Initiation of epidural analgesia—Local anesthetic pharmacology
6 Anesthesia for cesarean delivery
6.1 General considerations for anesthesia for cesarean delivery
6.1.1 Equipment set up
6.1.2 Prophylactic antibiotic dosing
7 Neuraxial anesthesia for cesarean delivery
7.1 Spinal anesthesia
7.2 Combined spinal epidural anesthesia
7.3 Continuous spinal anesthesia
7.4 Local anesthetic dosage
7.5 Phenylephrine dosage
7.6 Postdural puncture headache
8 General anesthesia for cesarean delivery
8.1 Unique challenges for general anesthesia for C-sections
8.1.1 Positioning
8.1.2 Preoxygenation
8.1.3 Induction
8.1.4 Intubation
8.1.5 Extubation
9 Postoperative pain management
10 Summary and conclusion
10.1 Neoplasm in pregnancy
10.1.1 Introduction and background
10.1.2 Preoperative assessment
10.1.3 Anesthesia for vaginal birth
10.1.4 Anesthesia for cesarean delivery
10.1.5 Anesthesia-related complications
Chapter 30. Anesthesia considerations for parturients with substance abuse or psychiatric disorders
1 Psychiatric disease and substance abuse in the parturient
2 Psychiatric diseases
3 Depression
4 Anxiety
5 Bipolar disorder
6 Schizophrenia
7 Substance use and abuse
8 Licit drugs
8.1 Tobacco
8.2 Alcohol
8.3 Caffeine
9 Illicit drugs
9.1 Marijuana
9.2 Cocaine
9.3 Amphetamines
9.4 Opioids
9.5 Hallucinogens
Chapter 31. Opioid use disorder in pregnancy
1 Introduction
2 Historical evolution and trends
3 Pregnancy and opioid use
4 Treatment of opioid use disorder
5 Pharmacology
5.1 Buprenorphine
5.2 Methadone
5.3 Naltrexone
6 Challenges in managing patients with an opioid use disorder
7 Barriers to effective analgesia
7.1 Antenatal considerations
7.2 Labor analgesia
7.3 Anesthesia and analgesia for cesarean delivery
8 Teams involved in managing patients with OUD
9 Neonatal effects
10 Breastfeeding
11 Conclusion
Chapter 32. Anesthesia considerations for patients with renal, hematologic, connective tissue, and immunologic diseases
1 Introduction
2 Issues related to this topic
2.1 Renal disease
2.1.1 Background
2.1.2 Historical evolution and trends
2.1.3 Characterization of renal injury: Acute and chronic
2.2 Selected pathophysiologic conditions leading to AKI and CKD
2.2.1 Lupus nephritis
2.2.2 Atypical hemolytic uremic syndrome
2.2.3 IgA nephropathy
2.2.4 Diabetic nephropathy
2.2.5 Nephrotic syndrome
2.2.6 ESRD with and without renal replacement therapy (RRT)
2.3 Treatment for renal disorders
2.3.1 Anesthesia management
3 Immunologic disease
3.1 Background
3.2 Historical evolution/trends
3.3 Multiple sclerosis and the related condition neuromyelitis optica
3.4 Myasthenia gravis (MG)
3.4.1 Treatment for MG
3.4.2 Obstetric management
3.4.3 Anesthetic management
3.5 Rheumatoid arthritis (RA)
3.6 Systemic lupus erythematosus
3.7 Sjogren's syndrome
3.8 Systemic sclerosis/scleroderma
3.9 Inflammatory bowel disease (IBD)
3.10 Autoimmune hepatitis (AIH)
4 Connective tissue diseases
4.1 Background
4.2 Historical evolution/trends
4.3 Selected connective tissue disorders with significant impact on obstetric and perioperative management
4.3.1 Marfan syndrome (MFS)
4.3.2 Loeys-Dietz syndrome
4.3.3 Ehlers–Danlos (EDS)
4.3.4 Hereditary hemorrhagic telangiectasia (HHT) (Osler-Weber-Rendu syndrome)
4.3.5 Osteogenesis imperfecta (OI)
4.3.6 Achondroplasia
5 Hematologic complications of pregnancy
5.1 Background
5.2 Historical evolution/trends
5.3 Selected hematologic disorders with significant impact on obstetric and perioperative management
5.3.1 Iron Deficiency Anemia
5.3.2 Megaloblastic anemia
5.3.3 Sickle cell disease (SCD)
5.3.4 Obstetric complications of SCD
5.4 Thrombocytopenia
5.5 Immune thrombocytopenia (ITP)
5.6 Hypertensive disease of pregnancy
6 Coagulation disorders
6.1 VWD
6.2 Acquired hemophilia
6.3 Procoagulant disorders
7 Future directions, novel treatments, or research studies
8 Summary and conclusion
Chapter 33. Anesthesia considerations for patients with COVID-19
1 Introduction
2 Pathophysiology
3 Risk factors
4 Diagnosis
5 Treatment
5.1 Preoperative assessment of COVID pregnant patient
5.1.1 The goals of preoperative evaluation of COVID pregnant patient
5.1.2 Preoperative evaluation include
5.2 Exclusion of acute phase of COVID infection
6 A respiratory complication of COVID-19 which indicates pre- or postoperative ventilation
7 Early diagnosis of pulmonary embolism
7.1 Preoperative medications
8 Preoperative assessment of intrauterine fetus
9 How to improve oxygenation in COVID-19 pregnant patient
9.1 Methods of improving oxygenation
9.2 High-flow nasal cannula
10 Noninvasive positive pressure ventilation
11 Extracorporeal membrane oxygenation
11.1 Preparation of the operating room for COVID patients
11.2 Equipments
11.3 Personal protection
Chapter 34. Anesthesia considerations for patients with preeclampsia
1 History of preeclampsia
2 Epidemiology
3 Pathophysiology
4 Histologic findings
5 Risk factors for preeclampsia development
6 Diagnostic criteria and clinical presentation
7 Morbidity and mortality
8 Risk stratification
9 Healthcare economic burden
10 Treatment of hypertensive disorders of pregnancy
11 Anesthetic considerations in preeclampsia
11.1 Cardiovascular
11.2 Fluid management
11.3 Neuraxial anesthesia
11.4 General anesthesia
11.5 Regional techniques
11.6 Uterotonic agents
11.7 Eclampsia management
Chapter 35. Anesthesia considerations for patients with infections, HIV, and sexually transmitted diseases
1 Introduction
2 Bacterial infections
2.1 General considerations
2.1.1 Chorioamnionitis
2.1.2 Urinary tract infections
2.1.3 Pneumonia
2.1.4 Sexually transmitted bacterial infections
2.2 Anesthetic management of the septic parturient
3 Viral infections
3.1 Human immunodeficiency virus
3.1.1 Treatment of HIV in pregnancy
3.1.2 Mode of delivery
3.1.3 Anesthetic considerations
3.2 Coronavirus disease 2019
3.2.1 Clinical manifestations of COVID-19 in pregnancy
3.2.2 Anesthesia concerns for the laboring patient with COVID-19
3.2.3 Postpartum care
3.3 Herpes simplex virus
3.4 Human papilloma virus
3.5 Hepatitis
3.6 Varicella
3.7 Others—cytomegalovirus, rubella, measles
4 Conclusion
Chapter 36. Anesthesia considerations with multiple births and fetal malpresentation
1 Anesthesia considerations for multiple births
1.1 Introduction
1.2 Definitions/epidemiology
1.3 Maternal physiologic changes
1.3.1 Cardiac
1.3.2 Hypertensive disorders of pregnancy
1.3.3 Central nervous system
1.4 Fetal morbidity in multiple gestation
1.4.1 Twin-to-twin transfusion syndrome
1.4.2 Intrauterine growth restriction and fetal growth discordance
1.4.3 Preterm labor and preterm delivery
1.5 Anesthetic management
1.5.1 Epidural analgesia for labor
1.5.2 Cesarean delivery in multiple gestations
2 Anesthesia for fetal malpresentation
2.1 Definitions and epidemiology
2.2 Obstetric considerations
2.3 Anesthetic considerations
Chapter 37. Anesthesia considerations for vaginal birth after C-section, and for abnormalities of the reproductive tract
1 Trial of labor after cesarean
1.1 Introduction
1.2 Background
1.3 Historical evolution and trends
1.4 Issues related to this topic
1.5 Anesthetic management
1.6 Other causes of uterine rupture
2 Abnormalities of the reproductive tract
2.1 Hymen malformations
2.2 Müllerian anomalies
2.3 Müllerian anomalies and effects on reproduction
2.4 Anesthetic considerations
Chapter 39. Anesthesia considerations for rare obstetric procedures: Cerclage placement, external cephalic version, and fetal intrauterine procedures
1 Cerclage
1.1 Background
1.2 Types of cerclage
1.3 Methods of cerclage placement
1.4 Anesthesia for cerclage placement
1.5 Cerclage removal
2 External cephalic version
2.1 Introduction
2.2 The impact of regional anesthesia or analgesia on ECV outcomes
2.3 Recommendations for regional anesthetic or analgesic techniques for ECV
2.4 Summary
3 Fetal intrauterine procedures
3.1 Operative techniques
3.2 Common indications
3.2.1 Myelomeningocele repair
3.2.2 Congenital diaphragmatic hernia repair
3.2.3 Ex-utero intrapartum procedure
3.2.4 Monochorionic twin complications
3.2.5 Intrauterine transfusions
3.3 Anesthesia considerations
Chapter 40. Anesthesia considerations for patients with spine surgery
1 Introduction
2 Pathophysiology, diagnosis, and treatment
2.1 Scoliosis
2.2 Discectomy and laminectomy
2.3 Chronic spinal cord injury
2.4 Spinal dysraphism
2.5 Implantable devices
3 Patient evaluation
4 Anesthetic management
4.1 The use of neuraxial ultrasound
4.2 Considerations for scoliosis
4.3 Considerations for chronic spinal cord injury
4.4 Considerations for spinal dysraphism
4.5 Considerations for the presence of implantable devices
4.6 Considerations for failed neuraxial and operative delivery
5 Future directions
6 Conclusion
Chapter 41. Anesthesia considerations for patients with special spine considerations including chronic spinal cord injury, spinal dysraphism, and implantable devices
1 Introduction
2 Pathophysiology, diagnosis, and treatment
2.1 Scoliosis
2.2 Discectomy and laminectomy
2.3 Chronic spinal cord injury
2.4 Spinal dysraphism
2.5 Implantable devices
3 Patient evaluation
4 Anesthetic management
4.1 The use of neuraxial ultrasound
4.2 Considerations for scoliosis
4.3 Considerations for chronic spinal cord injury
4.4 Considerations for spinal dysraphism
4.5 Considerations for the presence of implantable devices
4.6 Considerations for failed neuraxial and operative delivery
5 Future directions
6 Conclusion
Section IV. Obstetric complications
Chapter 42. Peripartum hemorrhage and management
1 Overview
2 Causes
3 Management of PPH
3.1 Stages of hemorrhagic shock
3.2 Transfusion protocols and use of TXA
3.2.1 Tranexamic acid
3.2.2 Transfusion protocols
3.2.3 Prothrombin complex and fibrinogen concentrates
3.2.4 Recombinant factor VII
3.3 Medical management
3.4 Surgical management
3.4.1 Intrauterine tamponade
3.4.2 Uterine artery embolization
3.4.3 Vascular ligation
3.4.4 Hysterectomy
3.5 Anesthetic evaluation and management
3.5.1 Preanesthetic evaluation
4 Anesthetic management
4.1 Preoperative checklist
4.2 Anesthetic induction and maintenance
4.3 Anesthetic risks and complications
4.4 Complications of postpartum hemorrhage
5 Special considerations: Placenta accreta spectrum
5.1 Anesthetic management
5.1.1 Preoperative
5.1.2 Intraoperative
5.1.3 Postoperative
6 Conclusion
Chapter 43. Point-of-care coagulation testing for obstetric hemorrhage
1 Postpartum hemorrhage (PPH) and need for point-of-care (POC) coagulation testing
2 Hemostasis: Normal pregnancy as compared to patients with PPH
3 Viscoelastic testing: ROTEM, TEG, others
3.1 Identification of hemostatic changes in pregnancy
3.2 Identification of clinical coagulopathy
4 Advantages of VTs
5 Disadvantages and limitations of viscoelastic tests
6 Other viscoelastic tests and new machines
7 Conclusion
Chapter 44. Trauma during pregnancy
1 Epidemiology
2 Maternal complications and outcomes
3 Fetal complications and outcomes
4 Assessment and resuscitation in pregnancy
4.1 Primary survey
4.1.1 Airway
4.1.2 Breathing
4.1.3 Circulation
4.2 Secondary survey
4.2.1 Fetal survey and monitoring
4.2.2 Laboratory studies
4.3 Cardiopulmonary resuscitation
5 Critical care during pregnancy
5.1 Preeclampsia/eclampsia
5.1.1 Introduction
5.1.2 Pathophysiology
5.1.3 Presentation and diagnosis
5.1.4 Management
5.1.5 Conclusion
5.2 Amniotic fluid embolism
5.2.1 Introduction
5.2.2 Pathophysiology
5.2.3 Presentation and diagnosis
5.2.4 Treatment
5.2.5 Conclusion
5.3 Cardiomyopathy in pregnancy
5.3.1 Introduction
5.3.2 Peripartum care
5.3.3 Postpartum care
5.3.4 Conclusion
5.4 Hemorrhagic shock in pregnancy
5.4.1 Introduction
5.4.2 Diagnosis
5.4.3 Risk factors
5.4.4 Management
5.4.5 Conclusion
5.5 Sepsis
5.5.1 Introductions
5.5.2 Pathophysiology
5.5.3 Presentation and diagnosis
5.5.4 Management
5.5.5 Conclusion
5.6 PRES
5.6.1 Introduction
5.6.2 Pathophysiology
5.6.3 Presentation and diagnosis
5.6.4 Treatments
5.6.5 Conclusion
Chapter 45. Postdural puncture headaches
1 Introduction
2 Pathophysiology
3 Incidence and risk factors
4 Prevention of PDPH after unintentional dural puncture
5 Clinical features and diagnosis of PDPH
6 Treatment options
6.1 Epidural blood patch
6.1.1 Efficacy
6.1.2 Risks
6.1.3 Contraindications
6.1.4 Special considerations
6.1.5 Procedure
6.2 Other treatments for PDPH
6.2.1 Conservative treatment
6.2.2 Medications
6.2.3 Nerve blocks
7 Long-term outcomes
8 Summary
Chapter 46. Fetal and neonatal assessment of complications and injuries (including abnormal labor, dystocia abnormalities of expulsive forces, abnormal presentation, position and development, and pelvic contraction)
1 Abnormal fetal presentation
1.1 Occiput-posterior (OP) presentation
2 Abnormal fetal testing
2.1 Tachysystole
2.2 Maternal hypotension
3 Labor complications
3.1 Cord prolapse
3.2 Chorioamnionitis
3.3 Uterine rupture
3.4 Uterine inversion
4 Delivery complications
4.1 Operative vaginal deliveries
4.2 Shoulder dystocia
5 Conclusion
Chapter 47. Hypotension and hypertension in pregnancy
1 Hypotensive disease of pregnancy
1.1 Introduction
2 Background
2.1 Definition of hypotension in obstetric patients
2.2 Issues related to this topic
2.3 Pathophysiology of hypotension in obstetrics
3 Risk factors
4 Patient evaluation
5 Diagnosis
6 Treatment
6.1 Left uterine displacement
7 Anesthetic management
8 Prevention
9 Global impact and challenges
10 Gestation hypertension and preeclampsia
11 Preeclampsia
12 Diagnostic criteria of preeclampsia
12.1 Hypertension
12.2 Proteinuria
12.3 Thrombocytopenia
12.4 Renal insufficiency
12.5 Impaired liver function
12.6 Abdominal pain
12.7 Pulmonary edema
12.8 Headache
13 Hemolysis, elevated liver enzymes, and low platelet count syndrome
14 Eclampsia
15 Gestational hypertension
16 Pathophysiology
17 Clinical recommendations and treatment
18 Anesthetic management
Chapter 48. Pulmonary aspiration and interventions to reduce the risk of aspiration
1 Background
2 History
3 Incidence
4 Physiology of pregnancy
5 Risk factors
6 Pathophysiology
7 Management
8 Prevention
Chapter 49. Amniotic fluid embolism
1 Introduction
2 Incidence
3 Diagnosis
3.1 Disseminated intravascular coagulation
3.2 Differential diagnosis
4 Risk factors
5 Pathophysiology
6 Pharmacology and treatment
7 Anesthesia considerations
Chapter 50. Intraamniotic infection
1 Introduction
2 Historical evolution
3 Pathophysiology
3.1 Microbiology
3.2 Risk factors
4 Patient evaluation
4.1 Initial evaluation
4.2 Clinical history
4.3 Physical examination
4.4 Laboratory testing
4.5 Imaging
5 Diagnosis
5.1 Steroids and leukocytosis
6 Treatment
6.1 Intrapartum
6.2 Length of antibiotic therapy
6.3 Isolated maternal fever considerations
7 Prevention
8 Clinical considerations
8.1 Dysfunctional labor
8.2 Maternal outcomes
8.3 Neonatal outcomes
9 Anesthetic management
10 Conclusion
Chapter 51. Preterm birth
1 Epidemiology of preterm birth
2 Risk factors for preterm birth
3 Pathophysiology of preterm birth
4 Prediction of preterm birth
5 Obstetric strategies to reduce risk of preterm birth and improve outcomes of premature neonates
5.1 Primary prevention of preterm birth
5.2 Secondary prevention of preterm birth
5.2.1 Progesterone
5.2.2 Cerclage
5.3 Tertiary prevention of preterm birth
5.3.1 Tocolytic drugs
6 Measures to improve neonatal outcome
6.1 Betamethasone
6.2 Magnesium sulfate for neuroprotection
6.3 Antibiotics
7 Anesthesia impact on fetal heart rate monitoring
7.1 Fetal heart rate monitoring in preterm fetus
7.2 Impact of perinatal anesthesia on the newborn
7.3 Analgesia for preterm labor and vaginal delivery
7.4 Anesthesia for cesarean delivery
7.5 Interactions between tocolytic therapy and anesthesia
Chapter 52. Neurologic complications from regional anesthesia and general anesthesia in obstetric practice
1 Introduction
2 Peripheral nerve injury
2.1 Mechanism
2.2 Risk factors
2.3 Lateral femoral cutaneous nerve
2.4 Femoral nerve
2.5 Obturator nerve
2.6 Lumbosacral plexus
2.7 Common peroneal nerve
2.8 Treatment and prevention
3 Central nervous injury
3.1 Unintentional dural puncture and postdural puncture headache
3.1.1 Cranial nerve palsies
3.1.2 Subdural hematoma
3.1.3 Pneumocephalus
3.2 Cerebral vein thrombosis
3.2.1 Incidence
3.2.2 Risk factors
3.2.3 Presentation, diagnosis, and treatment
3.2.4 Prevention
3.3 Spinal cord trauma
3.3.1 Incidence
3.3.2 Risk factors
3.3.3 Presentation, diagnosis, and treatment
3.3.4 Prevention
3.4 Anterior spinal artery syndrome
3.4.1 Incidence
3.4.2 Risk factors
3.4.3 Presentation, diagnosis, and treatment
3.4.4 Prevention
3.5 Spinal epidural hematoma
3.5.1 Incidence
3.5.2 Risk factors
3.5.3 Presentation, diagnosis, and treatment
3.6 Epidural abscess
3.6.1 Incidence
3.6.2 Risk factors
3.6.3 Presentation, diagnosis, and treatment
3.6.4 Prevention
3.7 Chemical injury and arachnoiditis
3.7.1 Incidence
3.7.2 Risk factors
3.7.3 Presentation, diagnosis, and treatment
3.8 Transient neurological symptoms
3.8.1 Incidence
3.8.2 Risk factors
3.8.3 Presentation, diagnosis, and treatment
4 Neurological complications from general anesthesia
4.1 Ulnar nerve
4.2 Brachial plexus
4.3 Common peroneal nerve
Chapter 53. Intraoperative and postoperative anesthesia-related morbidity and mortality, extremes of reproductive life, and abortion
1 Introduction
2 Anesthetic causes of maternal mortality
2.1 Management of the difficult airway in obstetrics
2.1.1 Introduction
2.1.2 Challenges and issues
2.1.3 Risk factors
2.1.4 Diagnosis and incidence
2.1.5 Treatment and pharmacology
2.1.6 Clinical issues and considerations
2.1.7 Global impact and challenges
2.1.8 Future directions and research
2.1.9 Mortality and its trends
2.1.10 Conclusion
2.2 Aspiration of gastric acid
2.2.1 Introduction
2.2.2 Issues related to aspiration of gastric acid
2.2.3 Pathophysiology
2.2.4 Risk factors
2.2.5 Diagnosis
2.2.6 Clinical considerations and conclusion
2.2.7 Prevention/treatment/anesthetic management
2.2.8 Global impact and challenges
2.2.9 Future directions and novel treatments
2.3 Maternal mortality and the complex landscape of local anesthetic toxicity
2.3.1 Pharmacology of local anesthetics
2.3.2 Factors contributing to local anesthetic toxicity
2.3.3 Clinical manifestations of local anesthetic toxicity
2.3.4 Management of local anesthetic toxicity
2.3.5 Preventive measures
2.4 Obstetric anesthesiologic mortality due to high spinal or epidural block: a comprehensive analysis
2.4.1 Introduction
2.4.2 Issues related to high spinal or epidural blocks
2.4.3 Pathophysiology
2.4.4 Risk factors
2.4.5 Diagnosis
2.4.6 Treatment/anesthetic management/pharmacology
2.4.7 Prevention and self-care
2.4.8 Global impact and challenges
2.4.9 Future directions, novel treatments, or research studies
3 Anesthetic causes of maternal morbidity
3.1 Postdural puncture headache
3.1.1 Pathophysiology
3.1.2 Risk factors and diagnosis
3.1.3 Treatment and anesthetic management
3.1.4 Clinical issues or considerations
3.1.5 Global impact and challenges
3.1.6 Future directions, novel treatments, or research studies
3.2 Postpartum neurologic deficits and related pathophysiology
3.2.1 Pathophysiology
3.2.2 Risk factors
3.2.3 Diagnosis and treatment
3.2.4 Prevention and self-care
3.2.5 Global impact and challenges
3.2.6 Future directions, novel treatments, or research studies
3.3 Postpartum back pain
3.3.1 Issues related to postpartum back pain
3.3.2 Pathophysiology
3.3.3 Risk factors
3.3.4 Diagnosis
3.3.5 Treatment and self-care
3.3.6 Pharmacological management
3.3.7 Global impact, clinical issues, and considerations
3.3.8 Side effects of spinal and epidural opiates
3.3.9 Treatment
3.3.10 Anesthetic management
3.3.11 Clinical issues or considerations
3.4 Common complications of extreme maternal ages and anesthesia management
3.4.1 Introduction
3.5 Anesthetic complications during a cesarean section
3.5.1 Maternal hypotension
3.5.2 Local anesthetic systemic toxicity
3.5.3 High regional block
3.6 Intrapartum and postpartum hemorrhage
3.6.1 Placenta previa
3.6.2 Uterine rupture
3.6.3 Uterine atony
3.7 Effect of anesthesia on preeclampsia and eclampsia
3.8 Anesthesia in preterm labor
3.8.1 Tocolytics
3.9 Common complications of anesthesia use during abortive procedures
3.9.1 Uterine perforation
3.9.2 Cervical tears
3.9.3 Disseminated intravascular coagulation
4 Conclusion
Chapter 54. Anesthesia for fetal surgery
1 Indications for fetal surgery
2 Anesthesia considerations in fetal surgery
2.1 Minimally invasive surgery
2.2 Open fetal surgery
2.3 Exit procedure
3 Anesthetic considerations for fetal surgery
3.1 Epidural
3.2 Regional anesthesia
3.3 General anesthesia
3.4 Gestational age considerations
3.5 Intraoperative fetal monitoring during fetal surgery
3.6 Rationale for fetal monitoring
3.7 Monitoring parameters and interpretation
3.8 Challenges and considerations
Chapter 55. Obstetric anesthesia and medicolegal/ethical issues
1 Introduction
2 Physiological changes in pregnancy relevant to anesthesia
3 Standard obstetric anesthesia techniques
4 Anesthetic management of obstetric complications
5 Medicolegal and ethical considerations in obstetric anesthesia
6 Informed consent in obstetric anesthesia
7 Liability issues in obstetric anesthesia
8 Ethical dilemmas in obstetric anesthesia
9 Cultural and religious considerations
10 Patient advocacy and rights
11 Future direction and innovations in obstetric anesthesia
12 Summary and conclusion
Section V. Fetus and newborn considerations
Chapter 56. Fetal evaluation, including the premature fetus and the compromised fetus
1 Antenatal surveillance
1.1 Fetal movement count
1.2 Fetal heart rate-based tests
1.2.1 Physiologic basis of fetal heart rate changes
1.2.2 Antepartum testing and interpretation
1.2.3 Effect of gestational age on FHR pattern and interpretation
1.3 Imaging-based tests
1.3.1 Estimation of gestational age
1.3.2 Anatomic survey
1.3.3 Biophysical profile
1.3.4 Growth scans
1.3.5 Doppler ultrasound
1.3.6 Assessment of lung maturity
2 Intrapartum fetal heart rate monitoring
2.1 NICHD classification, interpretation, and management of FHR patterns
3 Anesthesia in special situations
3.1 Twin to twin transfusion syndrome
3.1.1 Management
3.2 External cephalic version
3.3 Shoulder dystocia
3.3.1 Management
3.4 Intrauterine transfusion
Chapter 57. Fetal and neonatal complications and treatment, including resuscitation
1 Introduction
2 Antepartum management
2.1 Fetal heart rate monitoring
2.2 Rapid clincial assessment of suspected fetal hypoxemia and acidosis
2.3 Maternal positioning
2.4 Cessation of uterine stimulation
2.5 Intravenous fluid resuscitation
2.6 Tocolytics
2.7 Correction of maternal hypotension
2.8 Maternal oxygen supplementation
2.9 Amnioinfusion
2.10 Altering pushing efforts in labor
2.11 Cord prolapse
3 Newborn management
3.1 Role of obstetrical anesthesiologist in neonatal resuscitation
3.2 Transition from fetal circulation to newborn circulation
3.3 Team communication: Maternal team to neonatal team
3.4 Thermoregulation
3.5 Delayed cord clamping
3.6 Initial assessment of the newborn
3.7 Neonatal resuscitation
3.8 Assessing heart rate
3.9 Positive pressure ventilation
3.10 Newborn endotracheal intubation equipment
3.11 Target oxygenation saturation
3.12 Chest compressions
3.13 Epinephrine and volume resuscitation
3.14 Post resuscitation care
4 Neonatal complications
4.1 Pneumothorax and airway obstruction
5 Special considerations
6 Summary
Chapter 58. Diagnosis and treatment of fetal/newborn asphyxia and respiratory failure
1 Anesthetic management in the context of asphyxia and respiratory failure
2 Defining birth asphyxia
3 Historical evolution of birth asphyxia
4 Global impact and challenges
5 The fetus' cardiovascular response to asphyxia
6 Antenatal fetal surveillance for signs of chronic asphyxia
7 Intrapartum fetal heart rate assessment
8 Ancillary intrapartum fetal well-being assessments
9 Physiology of a neonatal hypoxic-ischemic brain injury
10 Evaluating for hypoxic ischemic encephalopathy
11 Therapeutic hypothermia and prognostication
12 Neonatal respiratory failure
12.1 Respiratory distress syndrome
13 Meconium-stained amniotic fluid and meconium aspiration syndrome
14 Congenital diaphragmatic hernia
15 Transient tachypnea of the newborn
16 Congenital pulmonary airway malformation
Chapter 59. Retrolental fibroplasia and anesthesia
1 Introduction
2 Epidemiology
3 Risk factors
4 Clinical considerations and anesthetic management
5 Patient evaluation
6 Prevention
7 Global impact and challenges
8 Diagnostic steps
9 Diagnostic modalities
10 Treatment
11 Advances in treatment
12 Clinical studies
13 Conclusion
Chapter 60. Long-term effects of anesthetics on the fetal and neonate
1 Introduction
2 Is there any empirical evidence demonstrating the teratogenic effects of anesthetic agents administered during the first trimester of pregnancy?
2.1 Nitrous oxide
2.2 Benzodiazepines
2.3 Opioids
2.4 Nonsteroidal antiinflammatory drugs
3 Fetal nervous systems development
4 Long-term effects of anesthetics administered during the second trimester on the fetus
5 Is it safe to administer anesthetics during the third trimester?
5.1 Is dexmedetomidine capable of providing brain protection against neuroapoptosis caused by inhalation of gases?
6 What are the drawbacks of the prior research?
7 Conclusion
Chapter 61. Illustrated ultrasound evaluation of the stomach fasting/nonfasting status
1 Introduction
2 Background
3 Gastric ultrasound as an effective clinical tool
4 Evolving concepts in clinical use of point-of care ultrasounds
5 Historical evolution and trends in gastric ultrasound
6 Pathophysiology
7 Risk factors
8 Patient evaluation
9 Diagnosis
10 Treatment
11 Anesthetic management
12 Pharmacology
13 Clinical issues or considerations
14 Prevention and self-care
15 Global impact and challenges
16 Future directions, novel treatments, or research studies
17 Summary and conclusion
Chapter 62. Ultrasound evaluation of the spinal vertebrae
1 Key summary points
2 Introduction
2.1 History
2.2 Benefits of neuraxial anesthesia
2.3 Traditional landmark approach
2.4 History of ultrasound-guided neuraxial anesthesia
3 Why use ultrasound?
4 Physics and anatomy
4.1 Physics of sonography
4.2 Gross anatomy of the lumbar spine
5 Technical procedure
5.1 Sonography of the lumbar spine
6 Conclusion
Chapter 63. Neurological injury after neuraxial anesthesia
1 Introduction/background
2 Incidence of nerve injuries
3 Intrinsic obstetric palsies
3.1 Lateral femoral cutaneous nerve
3.2 Femoral nerve
3.3 Obturator nerve
3.4 Lumbosacral plexus
3.5 Peroneal nerve
3.6 Sciatic nerve
3.7 Pudendal nerve
4 Anesthesia-related neurologic deficits
4.1 Postdural puncture headache
4.2 Spinal/epidural hematoma
4.3 Infection: epidural abscess and meningitis
4.4 Direct trauma
4.5 Chemical injury
4.6 Arachnoiditis
4.7 Transient neurologic syndrome
5 Medicolegal implications
6 Conclusion
Index

Life Sciences

Physical Sciences & Engineering

Social Sciences & Humanities

Health

Pharmacology, Physiology, and Practice in Obstetric Anesthesia

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Alan D. Kaye

Aaron J. Kaye

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