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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Request a sales quotePharmacology, 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
- Clearly addresses all the aspects of practice within the context of obstetrics, anesthesiology, and neonatal care
- Discusses new and relevant topics that are important to the field
- Provides up to date information in an accessible, user-friendly format
Clinicians, scientists, and healthcare providers in the field of obstetrics and gynecology.
Contributors
About the editors
Preface
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
Amber N. Edinoff, Brooke Williams, Layne Landry, Elyse M. Cornett and Alan David Kaye
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
3.4 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
5.2 Peripartum cardiomyopathy
5.3 Pulmonary changes in pregnancy
5.4 Postpartum depression
6. Conclusion
References
2. Anatomy of the reproductive tract: The placenta, uteroplacental circulation, anatomy, transfer of drugs, and respiratory gas exchange
Jessica Galey, Amy Zheng and Shobana Bharadwaj
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
3. Uterine blood flow and the effects of obstetric anesthesia
John Pallan, Amy Zheng, Jessica Galey and Shobana Bharadwaj
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
4. Perinatal pharmacology
Rucha Kelkar, Alina Smoleva, Therese Larson, Sahar Shekoohi and Alan David Kaye
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
References
5. Parturient anesthesia assessment and evaluation
Hrayr Ghazaryan, Artush Grigoryan and Lincoln Frederick Arbogast
1. Introduction
2. History of anesthesia in obstetrics
3. Physiological changes in pregnancy
3.1 Cardiovascular
3.2 Respiratory
3.3 Gastrointestinal
3.4 Urinary
3.5 Endocrine
3.6 Hematologic
3.7 Coagulation
4. Preanesthesia evaluation of parturients
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
5.2 Respiratory diseases
5.3 Anemias
5.4 Coagulation disorders
6. Endocrine diseases
6.1 Diabetes mellitus
6.2 Hyperthyroidism
6.3 Musculoskeletal disorders
6.4 Renal diseases
6.5 Liver diseases
7. Conclusion
References
6. How to create and maintain a safe and an efficient obstetric anesthesia practice
Anjum Anwar, Huma Wali and Hina Shamim
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
8.3 Recommendations
8.4 Anesthesia management of high-risk pregnancies
8.5 Peripartum obstetric hemorrhage
8.6 Concept of the pregnancy heart team and cardiac obstetrics
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
References
7. Obstetric anesthesia consultation
Courtney Hood, Kristen L. Fardelmann and Benjamin Cobb
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
References
8. Obstetric management of labor and delivery, including preoperative assessment and basic standards for preanesthesia care
Huma Wali, Haneen Alnazzawi and Anjum Anwar
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
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
References
9. Fetal assessment and physiology
Mariana Montes, Chad T. Dean and Thomas James
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
References
10. Opioid analgesics in labor
Peter Louis Kovacs, Jayanth Dasika and Venkata Satya Lakshmi Damalanka
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
8.5 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
References
11. Mechanisms of labor pain and anesthesia in healthy parturients
Justin Swengel and Patrick McConville
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
References
12. Nonopioid analgesia
Jayanth Dasika, Peter Louis Kovacs and Venkata Satya Lakshmi Damalanka
1. Nitrous oxide
2. Acetaminophen and nonsteroidal antiinflammatory drugs
3. Sedatives and analgesic adjuncts
References
13. Nonpharmacologic and alternative management of labor and delivery analgesia
David Gutman and Michael Marotta
1. Introduction
2. Water immersion
3. Biofeedback
4. Hypnosis
5. Acupuncture
6. Subcutaneous of intracutaneous sterile water injection
7. Manual/massage/reflexology
8. Conclusion
Reference
14. Local anesthetics and adjuvants in healthy obstetric patients
Jeffery Cao, Munfarid Zaidi, Lee Chang, Melissa Nikolaidis and Yi Deng
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
References
15. Epidural anatomy and epidural anesthesia for labor and cesarean delivery
Fatoumata Kromah and Nicholas Malki
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
References
Suggested readings
16. Neuraxial anesthesia for vaginal delivery
Kristin N. Bembenick, Angela Nguyen, Corrie Jackson, Sahar Shekoohi, Aaron J. Kaye, Alan D. Kaye and Harish Siddaiah
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
References
Suggested readings
17. Neuraxial analgesia for cesarean delivery
Andrew Jensen, Kevin Chen, Melissa Nikolaidis and Yi Deng
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
5.3 Procedural steps
5.4 Spinal placement
5.5 Procedural steps
5.6 Combine spinal-epidural placement
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
References
Further reading
18. General anesthesia for normal, uncomplicated cesarean delivery: Indications and strategies
Fatoumata Kromah
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
References
Additional suggested readings
19. Airway management of the pregnant patient for labor and cesarean delivery
Moataz Maher Emara, Mohamed Maher Elwaraky, Laila Alhafez and Sally Hamdy Abdelaziz Ahmed
1. Incidence of GA and difficult airways in the obstetric population
2. Physiological changes during pregnancy: Implications on airway management
2.1 Respiratory parameters and gas exchange alterations
2.2 Airway obstruction and difficulty in intubation
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
References
20. Postoperative pain management for cesarean delivery
Antonio Gonzalez Fiol, P.J. McGuire, Kristen L. Fardelmann and Aymen Awad Alian
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)
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)
References
21. Postoperative sterilization surgery and anesthesia considerations
Melissa Nikolaidis, Jacy Gressen, Tommy Li and Yi Deng
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
References
22. Anesthesia for assisted reproductive techniques
Fouzia Khalid and Amber Naz
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
References
23. Anesthesia considerations for pregnant patients with cardiovascular disease
Islam Mohammad Shehata Elsayed, Yasmeen Ahmed Mohamed Taha, Hala Mostafa Goma and Nesrine Abdel Rahman Elrefai
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
11. Peripartum cardiomyopathy
11.1 Cardiac tests for diagnosis 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
14.2 The type and severity of cardiac illness
14.3 How to conduct safe neuraxial anesthesia
15. Postpartum care
16. Conclusion
References
24. Anesthesia considerations for pregnant patients with lung disease
Adam Lin Wendling and Clinton Pillow
1. Introduction
2. Background
3. Issues related to this topic
4. Historical evolution/trends
5. Pathophysiology
6. Risk factors
6.1 Preexistent pulmonary disease
6.2 Acquired pulmonary 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
10. Anesthetic management
10.1 General principles
11. Global impact and challenges
12. Future directions, novel treatments, or research studies
13. Summary and conclusion
References
25. Anesthesia considerations for patients with renal, hematologic, connective tissue, and immunologic diseases
Rucha A. Kelkar, Alexandra D. Dautel, Lillian V. Lauck, Michael J. Quintana, Sahar Shekoohi and Alan David Kaye
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
References
26. Anesthesia considerations for parturients with endocrine disorders
Evan Nicholas Lian, Asher Le and Aladino De Ranieri
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
References
27. Anesthetic considerations for patients with neurologic disorders in pregnancy
Philip Rubin and Lisa Leffert
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
References
28. Anesthesia considerations for fetal growth restriction and macrosomia in pregnancy
Kylie Dufrene, James Ilochi, Caleigh Foto, Julia Hebert, Carlos Narvaez, Sahar Shekoohi and Alan David Kaye
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
2.6 Intraoperative complications associated with macrosomia
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
References
29. Anesthesia considerations for pregnant patients with morbid obesity and neoplasm
Erica Johnson, Teshi Kaushik and Christina Faya
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
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
9. Postoperative pain management
10. Summary and conclusion
10.1 Neoplasm in pregnancy
References
Further reading
30. Anesthesia considerations for parturients with substance abuse or psychiatric disorders
Justin Swengel and Patrick McConville
1. Psychiatric disease and substance abuse in the parturient 313
2. Psychiatric diseases 313
3. Depression 313
4. Anxiety 315
5. Bipolar disorder 316
6. Schizophrenia 317
7. Substance use and abuse 318
8. Licit drugs 318
8.1 Tobacco 318
8.2 Alcohol 319
8.3 Caffeine 320
9. Illicit drugs 320
9.1 Marijuana 320
9.2 Cocaine 321
9.3 Amphetamines 321
9.4 Opioids 322
9.5 Hallucinogens 324
References 325
Further reading 326
31. Opioid use disorder in pregnancy
Sonal Zambare, Lauren Brown-Berchtold and Amy I. Lee
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
References
32. Anesthesia considerations for patients with renal, hematologic, connective tissue, and immunologic diseases
Adam Lin Wendling and Seth Garrett
1. Introduction
2. Issues related to this topic
2.1 Renal disease
2.2 Selected pathophysiologic conditions leading to AKI and CKD
2.3 Treatment for renal disorders
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)
3.5 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
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
5.4 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
References
33. Anesthesia considerations for patients with COVID-19
Nesrine Refai, Hala Mostafa Goma, Islam Mohammad Shehata Elsayed and Ahmed Hashim
1. Introduction
2. Pathophysiology
3. Risk factors
4. Diagnosis
5. Treatment
5.1 Preoperative assessment of COVID pregnant patient
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
References
34. Anesthesia considerations for patients with preeclampsia
Alexandra Waits, Kennedy Kirkpatrick, Melissa Nikolaidis and Yi Deng
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
References
35. Anesthesia considerations for patients with infections, HIV, and sexually transmitted diseases
Claudia Wei and Amy I. Lee
1. Introduction
2. Bacterial infections
2.1 General considerations
2.2 Anesthetic management of the septic parturient
3. Viral infections
3.1 Human immunodeficiency virus
3.2 Coronavirus disease 2019
3.3 Herpes simplex virus
3.4 Human papilloma virus
3.5 Hepatitis
3.6 Varicella
3.7 Others-cytomegalovirus, rubella, measles
4. Conclusion
References
36. Anesthesia considerations with multiple births and fetal malpresentation
Joseph Bavaro, Candice Cuppini and Andrew Hallmark
1. Anesthesia considerations for multiple births
1.1 Introduction
1.2 Definitions/epidemiology
1.3 Maternal physiologic changes
1.4 Fetal morbidity in multiple gestation
1.5 Anesthetic management
2. Anesthesia for fetal malpresentation
2.1 Definitions and epidemiology
2.2 Obstetric considerations
2.3 Anesthetic considerations
References
37. Anesthesia considerations for vaginal birth after C-section, and for abnormalities of the reproductive tract
Emily Dinges
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 Mullerian anomalies
2.3 Mullerian anomalies and effects on reproduction
2.4 Anesthetic considerations
References
38. Anesthetic considerations for nonobstetric surgery during pregnancy
Kristin Horton and Mary Lynne Roberts
1. Introduction
2. Brief review of physiologic changes in pregnancy
2.1 Cardiovascular
2.2 Hematology
2.3 Pulmonary
2.4 Airway
2.5 Gastrointestinal
2.6 Neurologic and neuromuscular
2.7 Endocrine
2.8 Pharmacologic
2.9 Uteroplacental blood flow
2.10 Summary of physiologic changes
3. Preoperative assessment and management
3.1 Risks of surgery and general anesthesia during pregnancy
3.2 Timing of surgery
3.3 Choosing anesthetic type
3.4 Monitoring
3.5 Patient assessment
3.6 Premedications
3.7 Pain control and multimodal analgesia
3.8 Aspiration prophylaxis
3.9 Other medications
4. Intraoperative management
4.1 Positioning
4.2 Induction/airway
4.3 Hemodynamic and respiratory goals
4.4 Anesthetic medications and the fetus
4.5 Maternal code blue
4.6 Considerations for surgical subspecialty procedures
5. Postoperative management
5.1 Postoperative monitoring
5.2 Imaging
5.3 Pain management
6. Summary
References
39. Anesthesia considerations for rare obstetric procedures: Cerclage placement, external cephalic version, and fetal intrauterine procedures
Hani El-Omrani, Thanh-Giang Vu and Emily Dinges
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
3.3 Anesthesia considerations
References
40. Anesthesia considerations for patients with spine surgery
Alan David Kaye, Rucha A. Kelkar, Alexandra D. Dautel, Lillian V. Lauck, Michael J. Quintana, Shahab Ahmadzadeh and Sahar Shekoohi
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
References
41. Anesthesia considerations for patients with special spine considerations including chronic spinal cord injury, spinal dysraphism, and implantable devices
Mikayla Troughton, Helen Pappas and Carmen Lopez
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
References
42. Peripartum hemorrhage and management
Dana Darwish, Christopher Choi and Faiza A. Khan
1. Overview
2. Causes
3. Management of PPH
3.1 Stages of hemorrhagic shock
3.2 Transfusion protocols and use of TXA
3.3 Medical management
3.4 Surgical management
3.5 Anesthetic evaluation and management
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 accrete spectrum
5.1 Anesthetic management
6. Conclusion
References
43. Point-of-care coagulation testing for obstetric hemorrhage
Elvera L. Baron and Daniel Katz
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
References
44. Trauma during pregnancy
Joseph Abro, Grayce Davis, Rishi Patel and Travis Pecha
1. Epidemiology
2. Maternal complications and outcomes
3. Fetal complications and outcomes
4. Assessment and resuscitation in pregnancy
4.1 Primary survey
4.2 Secondary survey
4.3 Cardiopulmonary resuscitation
5. Critical care during pregnancy
5.1 Preeclampsia/eclampsia
5.2 Amniotic fluid embolism
5.3 Cardiomyopathy in pregnancy
5.4 Hemorrhagic shock in pregnancy
5.5 Sepsis
5.6 PRES
References
45. Postdural puncture headaches
Peter Arrabal, John Crowe, Andrea Girnius and Michael Hawryschuk
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
6.2 Other treatments for PDPH
7. Long-term outcomes
8. Summary
References
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)
Anusha Kallurkar, Jackie Hanners, Kristina Gambino and Dani Zoorob
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
References
47. Hypotension and hypertension in pregnancy
Daniel Hernandez-Barajas, Brooke Ingram Tsao and Jose Humanez
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
References
48. Pulmonary aspiration and interventions to reduce the risk of aspiration
Jason Gabriel Hirsch
1. Background
2. History
3. Incidence
4. Physiology of pregnancy
5. Risk factors
6. Pathophysiology
7. Management
8. Prevention
References
49. Amniotic fluid embolism
Brooke Ingram Tsao and Grace Cruz
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
References
50. Intraamniotic infection
Lauren Brown-Berchtold and Sterling Adams
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
References
51. Preterm birth
Edward Springel, Arunthevaraja Karuppiah, Miheret Yitayew, Nayef Chahin, Jenny R. Fox and Joseph A. Khoury
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
5.3 Tertiary prevention of preterm birth
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
References
52. Neurologic complications from regional anesthesia and general anesthesia in obstetric practice
Carmen Lopez, Mikayla Troughton and Emery McCrory
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
3.2 Cerebral vein thrombosis
3.3 Spinal cord trauma
3.4 Anterior spinal artery syndrome
3.5 Spinal epidural hematoma
3.6 Epidural abscess
3.7 Chemical injury and arachnoiditis
3.8 Transient neurological symptoms
4. Neurological complications from general anesthesia
4.1 Ulnar nerve
4.2 Brachial plexus
4.3 Common peroneal nerve
References
53. Intraoperative and postoperative anesthesia-related morbidity and mortality, extremes of reproductive life, and abortion
Alexander M. Aldanese, Fadi M. Huzien, Denver Stutler, Nikole K. Nikolov, Kylie Dufrene, Aaron J. Kaye, Harish Siddaiah, Sahar Shekoohi and Alan David Kaye
1. Introduction
2. Anesthetic causes of maternal mortality
2.1 Management of the difficult airway in obstetrics
2.2 Aspiration of gastric acid
2.3 Maternal mortality and the complex landscape of local anesthetic toxicity
2.4 Obstetric anesthesiologic mortality due to high spinal or epidural block: a comprehensive analysis
3. Anesthetic causes of maternal morbidity
3.1 Postdural puncture headache
3.2 Postpartum neurologic deficits and related pathophysiology
3.3 Postpartum back pain
3.4 Common complications of extreme maternal ages and anesthesia management
3.5 Anesthetic complications during a cesarean section
3.6 Intrapartum and postpartum hemorrhage
3.7 Effect of anesthesia on preeclampsia and eclampsia
3.8 Anesthesia in preterm labor
3.9 Common complications of anesthesia use during abortive procedures
4. Conclusion
References
54. Anesthesia for fetal surgery
Kylie Dufrene, Alexandra Dicke, Van Smith III, James Ilochi, John David Sawyer, Sahar Shekoohi and Alan David Kaye
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
References
55. Obstetric anesthesia and medicolegal/ethical issues
Alan David Kaye, Angela Nguyen, Emily Dantes, Cameron Robicheaux, Julia Trettin, Kylie Dufrene, Aaron J. Kaye, Sahar Shekoohi and Harish Siddaiah
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
References
56. Fetal evaluation, including the premature fetus and the compromised fetus
Hamdy Bakry Alqenawy, Mohamed Elmezaien, Rania Gamal El-Skaan and Mohamad Ismail
1. Antenatal surveillance
1.1 Fetal movement count
1.2 Fetal heart rate-based tests
1.3 Imaging-based tests
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
3.2 External cephalic version
3.3 Shoulder dystocia
3.4 Intrauterine transfusion
References
57. Fetal and neonatal complications and treatment, including resuscitation
Jenny R. Fox, Kelly Stanley, Edward Springel, Fatoumata Kromah and Joseph A. Khoury
1. Introduction
2. Antepartum management
2.1 Fetal heart rate monitoring
2.2 Rapid clinical 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
References
58. Diagnosis and treatment of fetal/newborn asphyxia and respiratory failure
Miheret Yitayew, Grace Mueller, Whitney Bender, Joseph A. Khoury, Fatoumata Kromah and Nayef Chahin
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
References
Further reading
59. Retrolental fibroplasia and anesthesia
Alan David Kaye, Evan Sinnathamby, Claire Fisher, Hannah Matejowsky, Kristin N. Bembenick, Thomas J. Tran, Shahab Ahmadzadeh and Sahar Shekoohi
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
References
60. Long-term effects of anesthetics on the fetal and neonate
Farzad Ebrahimi
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 anti-inflammatory 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
References
61. Illustrated ultrasound evaluation of the stomach fasting/nonfasting status
Sydney T. Gennaro-Dennis, Emily Johnson, Karlee Mott, Alex Wandler, Shahab Ahmadzadeh, Sahar Shekoohi and Alan David Kaye
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
References
62. Ultrasound evaluation of the spinal vertebrae
Emile Legendre, Grace Wester, Kristen Adams, Alison Hawkins, Varsha Allampalli, Sahar Shekoohi and Alan David Kaye
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
Acknowledgment
References
63. Neurological injury after neuraxial anesthesia
Ruba Elmaoued and Amy I. Lee
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
References
Index
About the editors
Preface
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
Amber N. Edinoff, Brooke Williams, Layne Landry, Elyse M. Cornett and Alan David Kaye
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
3.4 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
5.2 Peripartum cardiomyopathy
5.3 Pulmonary changes in pregnancy
5.4 Postpartum depression
6. Conclusion
References
2. Anatomy of the reproductive tract: The placenta, uteroplacental circulation, anatomy, transfer of drugs, and respiratory gas exchange
Jessica Galey, Amy Zheng and Shobana Bharadwaj
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
3. Uterine blood flow and the effects of obstetric anesthesia
John Pallan, Amy Zheng, Jessica Galey and Shobana Bharadwaj
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
4. Perinatal pharmacology
Rucha Kelkar, Alina Smoleva, Therese Larson, Sahar Shekoohi and Alan David Kaye
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
References
5. Parturient anesthesia assessment and evaluation
Hrayr Ghazaryan, Artush Grigoryan and Lincoln Frederick Arbogast
1. Introduction
2. History of anesthesia in obstetrics
3. Physiological changes in pregnancy
3.1 Cardiovascular
3.2 Respiratory
3.3 Gastrointestinal
3.4 Urinary
3.5 Endocrine
3.6 Hematologic
3.7 Coagulation
4. Preanesthesia evaluation of parturients
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
5.2 Respiratory diseases
5.3 Anemias
5.4 Coagulation disorders
6. Endocrine diseases
6.1 Diabetes mellitus
6.2 Hyperthyroidism
6.3 Musculoskeletal disorders
6.4 Renal diseases
6.5 Liver diseases
7. Conclusion
References
6. How to create and maintain a safe and an efficient obstetric anesthesia practice
Anjum Anwar, Huma Wali and Hina Shamim
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
8.3 Recommendations
8.4 Anesthesia management of high-risk pregnancies
8.5 Peripartum obstetric hemorrhage
8.6 Concept of the pregnancy heart team and cardiac obstetrics
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
References
7. Obstetric anesthesia consultation
Courtney Hood, Kristen L. Fardelmann and Benjamin Cobb
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
References
8. Obstetric management of labor and delivery, including preoperative assessment and basic standards for preanesthesia care
Huma Wali, Haneen Alnazzawi and Anjum Anwar
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
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
References
9. Fetal assessment and physiology
Mariana Montes, Chad T. Dean and Thomas James
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
References
10. Opioid analgesics in labor
Peter Louis Kovacs, Jayanth Dasika and Venkata Satya Lakshmi Damalanka
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
8.5 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
References
11. Mechanisms of labor pain and anesthesia in healthy parturients
Justin Swengel and Patrick McConville
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
References
12. Nonopioid analgesia
Jayanth Dasika, Peter Louis Kovacs and Venkata Satya Lakshmi Damalanka
1. Nitrous oxide
2. Acetaminophen and nonsteroidal antiinflammatory drugs
3. Sedatives and analgesic adjuncts
References
13. Nonpharmacologic and alternative management of labor and delivery analgesia
David Gutman and Michael Marotta
1. Introduction
2. Water immersion
3. Biofeedback
4. Hypnosis
5. Acupuncture
6. Subcutaneous of intracutaneous sterile water injection
7. Manual/massage/reflexology
8. Conclusion
Reference
14. Local anesthetics and adjuvants in healthy obstetric patients
Jeffery Cao, Munfarid Zaidi, Lee Chang, Melissa Nikolaidis and Yi Deng
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
References
15. Epidural anatomy and epidural anesthesia for labor and cesarean delivery
Fatoumata Kromah and Nicholas Malki
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
References
Suggested readings
16. Neuraxial anesthesia for vaginal delivery
Kristin N. Bembenick, Angela Nguyen, Corrie Jackson, Sahar Shekoohi, Aaron J. Kaye, Alan D. Kaye and Harish Siddaiah
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
References
Suggested readings
17. Neuraxial analgesia for cesarean delivery
Andrew Jensen, Kevin Chen, Melissa Nikolaidis and Yi Deng
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
5.3 Procedural steps
5.4 Spinal placement
5.5 Procedural steps
5.6 Combine spinal-epidural placement
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
References
Further reading
18. General anesthesia for normal, uncomplicated cesarean delivery: Indications and strategies
Fatoumata Kromah
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
References
Additional suggested readings
19. Airway management of the pregnant patient for labor and cesarean delivery
Moataz Maher Emara, Mohamed Maher Elwaraky, Laila Alhafez and Sally Hamdy Abdelaziz Ahmed
1. Incidence of GA and difficult airways in the obstetric population
2. Physiological changes during pregnancy: Implications on airway management
2.1 Respiratory parameters and gas exchange alterations
2.2 Airway obstruction and difficulty in intubation
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
References
20. Postoperative pain management for cesarean delivery
Antonio Gonzalez Fiol, P.J. McGuire, Kristen L. Fardelmann and Aymen Awad Alian
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)
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)
References
21. Postoperative sterilization surgery and anesthesia considerations
Melissa Nikolaidis, Jacy Gressen, Tommy Li and Yi Deng
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
References
22. Anesthesia for assisted reproductive techniques
Fouzia Khalid and Amber Naz
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
References
23. Anesthesia considerations for pregnant patients with cardiovascular disease
Islam Mohammad Shehata Elsayed, Yasmeen Ahmed Mohamed Taha, Hala Mostafa Goma and Nesrine Abdel Rahman Elrefai
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
11. Peripartum cardiomyopathy
11.1 Cardiac tests for diagnosis 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
14.2 The type and severity of cardiac illness
14.3 How to conduct safe neuraxial anesthesia
15. Postpartum care
16. Conclusion
References
24. Anesthesia considerations for pregnant patients with lung disease
Adam Lin Wendling and Clinton Pillow
1. Introduction
2. Background
3. Issues related to this topic
4. Historical evolution/trends
5. Pathophysiology
6. Risk factors
6.1 Preexistent pulmonary disease
6.2 Acquired pulmonary 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
10. Anesthetic management
10.1 General principles
11. Global impact and challenges
12. Future directions, novel treatments, or research studies
13. Summary and conclusion
References
25. Anesthesia considerations for patients with renal, hematologic, connective tissue, and immunologic diseases
Rucha A. Kelkar, Alexandra D. Dautel, Lillian V. Lauck, Michael J. Quintana, Sahar Shekoohi and Alan David Kaye
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
References
26. Anesthesia considerations for parturients with endocrine disorders
Evan Nicholas Lian, Asher Le and Aladino De Ranieri
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
References
27. Anesthetic considerations for patients with neurologic disorders in pregnancy
Philip Rubin and Lisa Leffert
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
References
28. Anesthesia considerations for fetal growth restriction and macrosomia in pregnancy
Kylie Dufrene, James Ilochi, Caleigh Foto, Julia Hebert, Carlos Narvaez, Sahar Shekoohi and Alan David Kaye
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
2.6 Intraoperative complications associated with macrosomia
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
References
29. Anesthesia considerations for pregnant patients with morbid obesity and neoplasm
Erica Johnson, Teshi Kaushik and Christina Faya
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
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
9. Postoperative pain management
10. Summary and conclusion
10.1 Neoplasm in pregnancy
References
Further reading
30. Anesthesia considerations for parturients with substance abuse or psychiatric disorders
Justin Swengel and Patrick McConville
1. Psychiatric disease and substance abuse in the parturient 313
2. Psychiatric diseases 313
3. Depression 313
4. Anxiety 315
5. Bipolar disorder 316
6. Schizophrenia 317
7. Substance use and abuse 318
8. Licit drugs 318
8.1 Tobacco 318
8.2 Alcohol 319
8.3 Caffeine 320
9. Illicit drugs 320
9.1 Marijuana 320
9.2 Cocaine 321
9.3 Amphetamines 321
9.4 Opioids 322
9.5 Hallucinogens 324
References 325
Further reading 326
31. Opioid use disorder in pregnancy
Sonal Zambare, Lauren Brown-Berchtold and Amy I. Lee
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
References
32. Anesthesia considerations for patients with renal, hematologic, connective tissue, and immunologic diseases
Adam Lin Wendling and Seth Garrett
1. Introduction
2. Issues related to this topic
2.1 Renal disease
2.2 Selected pathophysiologic conditions leading to AKI and CKD
2.3 Treatment for renal disorders
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)
3.5 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
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
5.4 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
References
33. Anesthesia considerations for patients with COVID-19
Nesrine Refai, Hala Mostafa Goma, Islam Mohammad Shehata Elsayed and Ahmed Hashim
1. Introduction
2. Pathophysiology
3. Risk factors
4. Diagnosis
5. Treatment
5.1 Preoperative assessment of COVID pregnant patient
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
References
34. Anesthesia considerations for patients with preeclampsia
Alexandra Waits, Kennedy Kirkpatrick, Melissa Nikolaidis and Yi Deng
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
References
35. Anesthesia considerations for patients with infections, HIV, and sexually transmitted diseases
Claudia Wei and Amy I. Lee
1. Introduction
2. Bacterial infections
2.1 General considerations
2.2 Anesthetic management of the septic parturient
3. Viral infections
3.1 Human immunodeficiency virus
3.2 Coronavirus disease 2019
3.3 Herpes simplex virus
3.4 Human papilloma virus
3.5 Hepatitis
3.6 Varicella
3.7 Others-cytomegalovirus, rubella, measles
4. Conclusion
References
36. Anesthesia considerations with multiple births and fetal malpresentation
Joseph Bavaro, Candice Cuppini and Andrew Hallmark
1. Anesthesia considerations for multiple births
1.1 Introduction
1.2 Definitions/epidemiology
1.3 Maternal physiologic changes
1.4 Fetal morbidity in multiple gestation
1.5 Anesthetic management
2. Anesthesia for fetal malpresentation
2.1 Definitions and epidemiology
2.2 Obstetric considerations
2.3 Anesthetic considerations
References
37. Anesthesia considerations for vaginal birth after C-section, and for abnormalities of the reproductive tract
Emily Dinges
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 Mullerian anomalies
2.3 Mullerian anomalies and effects on reproduction
2.4 Anesthetic considerations
References
38. Anesthetic considerations for nonobstetric surgery during pregnancy
Kristin Horton and Mary Lynne Roberts
1. Introduction
2. Brief review of physiologic changes in pregnancy
2.1 Cardiovascular
2.2 Hematology
2.3 Pulmonary
2.4 Airway
2.5 Gastrointestinal
2.6 Neurologic and neuromuscular
2.7 Endocrine
2.8 Pharmacologic
2.9 Uteroplacental blood flow
2.10 Summary of physiologic changes
3. Preoperative assessment and management
3.1 Risks of surgery and general anesthesia during pregnancy
3.2 Timing of surgery
3.3 Choosing anesthetic type
3.4 Monitoring
3.5 Patient assessment
3.6 Premedications
3.7 Pain control and multimodal analgesia
3.8 Aspiration prophylaxis
3.9 Other medications
4. Intraoperative management
4.1 Positioning
4.2 Induction/airway
4.3 Hemodynamic and respiratory goals
4.4 Anesthetic medications and the fetus
4.5 Maternal code blue
4.6 Considerations for surgical subspecialty procedures
5. Postoperative management
5.1 Postoperative monitoring
5.2 Imaging
5.3 Pain management
6. Summary
References
39. Anesthesia considerations for rare obstetric procedures: Cerclage placement, external cephalic version, and fetal intrauterine procedures
Hani El-Omrani, Thanh-Giang Vu and Emily Dinges
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
3.3 Anesthesia considerations
References
40. Anesthesia considerations for patients with spine surgery
Alan David Kaye, Rucha A. Kelkar, Alexandra D. Dautel, Lillian V. Lauck, Michael J. Quintana, Shahab Ahmadzadeh and Sahar Shekoohi
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
References
41. Anesthesia considerations for patients with special spine considerations including chronic spinal cord injury, spinal dysraphism, and implantable devices
Mikayla Troughton, Helen Pappas and Carmen Lopez
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
References
42. Peripartum hemorrhage and management
Dana Darwish, Christopher Choi and Faiza A. Khan
1. Overview
2. Causes
3. Management of PPH
3.1 Stages of hemorrhagic shock
3.2 Transfusion protocols and use of TXA
3.3 Medical management
3.4 Surgical management
3.5 Anesthetic evaluation and management
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 accrete spectrum
5.1 Anesthetic management
6. Conclusion
References
43. Point-of-care coagulation testing for obstetric hemorrhage
Elvera L. Baron and Daniel Katz
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
References
44. Trauma during pregnancy
Joseph Abro, Grayce Davis, Rishi Patel and Travis Pecha
1. Epidemiology
2. Maternal complications and outcomes
3. Fetal complications and outcomes
4. Assessment and resuscitation in pregnancy
4.1 Primary survey
4.2 Secondary survey
4.3 Cardiopulmonary resuscitation
5. Critical care during pregnancy
5.1 Preeclampsia/eclampsia
5.2 Amniotic fluid embolism
5.3 Cardiomyopathy in pregnancy
5.4 Hemorrhagic shock in pregnancy
5.5 Sepsis
5.6 PRES
References
45. Postdural puncture headaches
Peter Arrabal, John Crowe, Andrea Girnius and Michael Hawryschuk
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
6.2 Other treatments for PDPH
7. Long-term outcomes
8. Summary
References
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)
Anusha Kallurkar, Jackie Hanners, Kristina Gambino and Dani Zoorob
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
References
47. Hypotension and hypertension in pregnancy
Daniel Hernandez-Barajas, Brooke Ingram Tsao and Jose Humanez
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
References
48. Pulmonary aspiration and interventions to reduce the risk of aspiration
Jason Gabriel Hirsch
1. Background
2. History
3. Incidence
4. Physiology of pregnancy
5. Risk factors
6. Pathophysiology
7. Management
8. Prevention
References
49. Amniotic fluid embolism
Brooke Ingram Tsao and Grace Cruz
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
References
50. Intraamniotic infection
Lauren Brown-Berchtold and Sterling Adams
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
References
51. Preterm birth
Edward Springel, Arunthevaraja Karuppiah, Miheret Yitayew, Nayef Chahin, Jenny R. Fox and Joseph A. Khoury
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
5.3 Tertiary prevention of preterm birth
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
References
52. Neurologic complications from regional anesthesia and general anesthesia in obstetric practice
Carmen Lopez, Mikayla Troughton and Emery McCrory
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
3.2 Cerebral vein thrombosis
3.3 Spinal cord trauma
3.4 Anterior spinal artery syndrome
3.5 Spinal epidural hematoma
3.6 Epidural abscess
3.7 Chemical injury and arachnoiditis
3.8 Transient neurological symptoms
4. Neurological complications from general anesthesia
4.1 Ulnar nerve
4.2 Brachial plexus
4.3 Common peroneal nerve
References
53. Intraoperative and postoperative anesthesia-related morbidity and mortality, extremes of reproductive life, and abortion
Alexander M. Aldanese, Fadi M. Huzien, Denver Stutler, Nikole K. Nikolov, Kylie Dufrene, Aaron J. Kaye, Harish Siddaiah, Sahar Shekoohi and Alan David Kaye
1. Introduction
2. Anesthetic causes of maternal mortality
2.1 Management of the difficult airway in obstetrics
2.2 Aspiration of gastric acid
2.3 Maternal mortality and the complex landscape of local anesthetic toxicity
2.4 Obstetric anesthesiologic mortality due to high spinal or epidural block: a comprehensive analysis
3. Anesthetic causes of maternal morbidity
3.1 Postdural puncture headache
3.2 Postpartum neurologic deficits and related pathophysiology
3.3 Postpartum back pain
3.4 Common complications of extreme maternal ages and anesthesia management
3.5 Anesthetic complications during a cesarean section
3.6 Intrapartum and postpartum hemorrhage
3.7 Effect of anesthesia on preeclampsia and eclampsia
3.8 Anesthesia in preterm labor
3.9 Common complications of anesthesia use during abortive procedures
4. Conclusion
References
54. Anesthesia for fetal surgery
Kylie Dufrene, Alexandra Dicke, Van Smith III, James Ilochi, John David Sawyer, Sahar Shekoohi and Alan David Kaye
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
References
55. Obstetric anesthesia and medicolegal/ethical issues
Alan David Kaye, Angela Nguyen, Emily Dantes, Cameron Robicheaux, Julia Trettin, Kylie Dufrene, Aaron J. Kaye, Sahar Shekoohi and Harish Siddaiah
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
References
56. Fetal evaluation, including the premature fetus and the compromised fetus
Hamdy Bakry Alqenawy, Mohamed Elmezaien, Rania Gamal El-Skaan and Mohamad Ismail
1. Antenatal surveillance
1.1 Fetal movement count
1.2 Fetal heart rate-based tests
1.3 Imaging-based tests
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
3.2 External cephalic version
3.3 Shoulder dystocia
3.4 Intrauterine transfusion
References
57. Fetal and neonatal complications and treatment, including resuscitation
Jenny R. Fox, Kelly Stanley, Edward Springel, Fatoumata Kromah and Joseph A. Khoury
1. Introduction
2. Antepartum management
2.1 Fetal heart rate monitoring
2.2 Rapid clinical 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
References
58. Diagnosis and treatment of fetal/newborn asphyxia and respiratory failure
Miheret Yitayew, Grace Mueller, Whitney Bender, Joseph A. Khoury, Fatoumata Kromah and Nayef Chahin
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
References
Further reading
59. Retrolental fibroplasia and anesthesia
Alan David Kaye, Evan Sinnathamby, Claire Fisher, Hannah Matejowsky, Kristin N. Bembenick, Thomas J. Tran, Shahab Ahmadzadeh and Sahar Shekoohi
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
References
60. Long-term effects of anesthetics on the fetal and neonate
Farzad Ebrahimi
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 anti-inflammatory 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
References
61. Illustrated ultrasound evaluation of the stomach fasting/nonfasting status
Sydney T. Gennaro-Dennis, Emily Johnson, Karlee Mott, Alex Wandler, Shahab Ahmadzadeh, Sahar Shekoohi and Alan David Kaye
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
References
62. Ultrasound evaluation of the spinal vertebrae
Emile Legendre, Grace Wester, Kristen Adams, Alison Hawkins, Varsha Allampalli, Sahar Shekoohi and Alan David Kaye
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
Acknowledgment
References
63. Neurological injury after neuraxial anesthesia
Ruba Elmaoued and Amy I. Lee
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
References
Index
- Edition: 1
- Published: March 31, 2025
- Imprint: Academic Press
- Language: English
- Paperback ISBN: 9780443217074
- eBook ISBN: 9780443217067
AK
Alan D. Kaye
Dr. Alan David Kaye, MD, PhD, attended the University of Arizona in Tucson for college and medical school. He also completed his PhD in Vascular Pharmacology at Tulane School of Medicine in New Orleans. Dr. Kaye is the Immediate Former Vice Chancellor of Academic Affairs, Chief Academic Officer, Provost, Pain Fellowship Program Director, and Tenured Professor in the Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences at Louisiana State University Health Sciences Center in Shreveport. He is also the Vice Chairman of Research and Tenured Professor in the Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences at the Louisiana State University School of Medicine. He served as Program Director and Chairman of anesthesia for 21 years, for 6 years at Texas Tech Health Sciences Center in Lubbock, Texas, and for 15 years at LSU Health Sciences Center in New Orleans, Louisiana, and was a member of the FDA Advisory Committee on Anesthetics, Analgesics, and Addiction Medicine from 2012 to 2020.
Affiliations and expertise
Immediate Former Vice Chancellor of Academic Affairs, Chief Academic Officer, and Provost; Pain Program Fellowship Director, Vice Chairman of Research, Professor, Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences; Louisiana State University School of Medicine, Shreveport, USAAK
Aaron J. Kaye
Dr. Aaron Joshua Kaye, MD, graduated from Stanford University in Palo Alto, California, and the Medical University of South Carolina in Charleston, South Carolina. He completed his anesthesia residency at the Medical University of South Carolina in Charleston, South Carolina, and is in private practice with Wake Anesthesiology in Raleigh, North Carolina.
Affiliations and expertise
Attending Staff, Wake Anesthesia Group, ECAA Anesthesia Specialists, Raleigh, USARead Pharmacology, Physiology, and Practice in Obstetric Anesthesia on ScienceDirect