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- Obstetric Anesthesia in High-Risk Situations
Pregnancy and delivery are considered "high-risk" when accompanied by conditions unfavorable to the well-being of the mother or unborn baby or both. Analgesia management in acute and chronic fetal distress and in maternal complications such as preeclampsia, eclampsia, hypertension, heart disease, renal disease, neurologic disorder, obesity, substance abuse and diabetes are affected by it. The analgesic management of obstetric complications such as placenta previa, cord prolapse, abruptio placentae, prematurity, multiple gestation, and breech presentation may increase the risk to the mother or the fetus. There is less room for error because many of these functions may be compromised before the induction of anesthesia. Significant acidosis is prone to develop in fetuses of diabetic mothers when delivered by cesarean section with spinal anesthesia complicated by even brief maternal hypotension. Because the high-risk pregnant patients may have received a variety of drugs, anesthesiologists must be familiar with potential interactions between these drugs and the anesthetic drugs they plan to administer. - Analgesia & Anesthesia
The terms analgesia and anesthesia are sometimes confused in common usage. Obstetric analgesia is the loss or regulation of pain perception during labor. It may be local and affect only a small area of the body; regional and affect a larger portion; or systemic. Analgesia is achieved by the use of hypnosis (suggestion), systemic medication, regional agents, or inhalation agents. Anesthesia is the total loss of sensory perception, and may include loss of consciousness. It is induced by various agents and techniques. In obstetrics, regional anesthesia is accomplished with local anesthetic techniques (epidural, spinal) and general anesthesia with systemic medication and endotracheal intubation. It is helpful in decreasing maternal and neonatal mortality and morbidity. Labor results in severe pain for many women. Pain management should be provided whenever it is medically indicated. The use of techniques and medications to provide pain relief in obstetrics requires and expert understanding of their effects to ensure the safety of both mother and fetus.
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www.womenshealthsection.com