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Pain Management During Labor and Delivery

• Editor's Note
• List of Articles

List of Articles

• Nitrous Oxide Analgesia for Labor
  Nitrous oxide, commonly known as “laughing gas,” is a tasteless and odorless gas used as a labor analgesic by some hospitals. It reduces anxiety and increases a feeling of well-being so that pain is easier to deal with. Face mask, which is used for administration of inhaled anesthetics, should be available in a variety of sized to fit each patient properly. The mask should be pliable and provide as effective a seal as possible against leakage into the surrounding air. Nitrous oxide is fairly safe for the patient and her baby. Because the serum half-life of nitrous oxide in the mother is short and the drug is not expected to be absorbed by the infant, no waiting period or discarding of milk is required. Overall, experience with nitrous oxide for intrapartum analgesia is positive and can be safely used in low-risk patients.
  
  
• Obstetric Anesthesia: Complications and Management
  During pregnancy, there are major alterations in nearly every maternal organ system. These changes are initiated by hormones secreted by the corpus luteum and placenta. The mechanical effects of the enlarging uterus and compression of surrounding structures play an increasing role in the second and third trimesters. This altered physiologic state had relevant implications for the anesthesiologist caring for the pregnant patient. Any drug that reaches the fetus undergoes metabolism and excretion. Well-conducted obstetric analgesia and anesthesia, in addition to relieving pain and anxiety, may benefit the mother. Placental drug uptake is limited, and there is no evidence to suggest that this organ metabolizes any of the agents commonly used in obstetric anesthesia. The idea that surgical anesthesia, although deemed necessary for the patient, might have detrimental effects on the growth and development of the human fetus has led to a great deal of investigation, both in-vitro and in experimental animals. Because a single exposure to anesthetic agents seems unlikely to result in fetal abnormalities, the selection of agent should be based on specific surgical requirements.
  
  
• Obesity and Anesthesia
  The worldwide prevalence of obesity has increased substantially over the past few decades. Economic, technologic, and life style changes have created an abundance of cheap, high-calorie food coupled with decreased required physical activity. The purpose of this document is to review pathophysiology of obesity and challenges it poses for obstetrical anesthesia. The incidence of maternal obesity and its attendant comorbid conditions (diabetes, cardiovascular disease) continues to increase at an alarming rate, with major public health implications. Obese patients should be counseled before labor, advising them what intrapartum complications to anticipate. This also includes an anesthesia consult, especially to evaluate the airway.
  
  
• Overview of Obstetric Anesthesia Professional Liability
  Nearly in two decades, a review of liability associated with obstetric anesthesia using the American Society of Anesthesiologists (ASA) Closed Claim database found that, although awards to plaintiffs were higher in obstetric claims from the 1970s and 1980s, there were more claims for minor complications in obstetric compared to non-obstetric claims. The most common complications in obstetric claims were newborn death or brain damage (29%) and maternal death (22%). Over the past three decades, there have been numerous changes in the practice of anesthesiology in general and in the practice of obstetric anesthesia specifically. Specifically explored are the contribution of newborn death and brain damage compared to maternal death and brain damage to obstetric anesthesia liability in 1990 or later claims. This review should spur us to examine and change our practices to minimize both patient harm and our liability when we are not at fault. Only closed claim analyses can help us understand the conditions under which fatal and non-fatal injuries lead to litigation.
  
  

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