Labor Stage 1: Obstetric Anesthesia

by Veronica Gillispie, MD, FACOG

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    00:01 Now let's discuss Obstetric Anesthesia.

    00:05 So we have a lot of options for managing pain in labor.

    00:09 Let's take time to talk about each of these.

    00:11 First is inhaled anesthesia.

    00:15 So this is in the form of nitrous oxide also known as Laughing Gas.

    00:19 It's inhaled intermittently in labor.

    00:21 Mom is in control of that.

    00:24 Pain relief however is minimal and is short lasting.

    00:28 The side effects are nausea, dizziness and light headedness.

    00:32 Nitrous oxide can be used for labor but not for cesarean sections.

    00:39 Now let's talk about systemic opoid anesthesia.

    00:44 So basically narcotics are given intravenously.

    00:46 We have to be careful though because if they are given intravenously, that means that they go to the placenta and they can effect the fetus.

    00:54 Pain relief is minimal and short lasting.

    00:57 And they should not be given within 4 hours prior to expected to delivery.

    01:02 Again because it is intravenous it goes to the placenta and the fetus can give the affects of the narcotic.

    01:10 Maternal side effects are nausea, vomiting and drowsiness.

    01:15 Fetal or neonatal side effects are fetal heart rate abnormalities or respiratory depression.

    01:22 Now let's talk about local opoid anesthesia.

    01:28 So this would be in the form of pudental nerve block as demonstrated here.

    01:34 It could be used for operative vaginal delivery or repair of laceration or episiotomy.

    01:39 So it's not typically used during the labor process.

    01:42 And it cannot be used for cesarean sections as it would not provide anesthesia to the area needed.

    01:47 But it can be used when you're using operative vaginal delivery.

    01:51 It provides great pain relief along the nerve distribution.

    01:55 Now you have to be cautious when you're doing a pudental nerve block because you can have potential hemorrhage if the pudental artery is accessed instead of the nerve.

    02:04 Now, let's talk about regional opoid anesthesia.

    02:10 So this is in the form of epidural or spinal.

    02:13 So epidural anesthesia typically used for labor but it can be used for C-section.

    02:19 During epidural placement a catheter is placed in the epidural space to inject medication.

    02:25 It gives great pain relief from T8 to below but it can be spotty.

    02:31 That means that patients can have what they call Hot Spots where they don't feel the pain relief in that area.

    02:38 Now the maternal side effect of an epidural is hypotension.

    02:41 This is particularly important specially for labor in patients.

    02:45 With that hypotension patients can experience utero-placental insufficiency and that can affect the fetus.

    02:52 And the fetus will manifest having that hypotension by having late decelerations.

    02:59 So spinal anesthesia.

    03:00 This is injected into the spinal fluid and it's used for C-sections.

    03:05 It gives great relief from T10 to below.

    03:07 So a little bit lower than an epidural and it last from between 2 to 4 hours.

    03:13 Again the maternal side effect is hypotension and bradycardia.

    03:17 And with that again, the fetus can start to have late decelerations as a manifestation of utero-placental insufficiency.

    03:27 Now let's talk about general anesthesia.

    03:31 So general anesthesia is reserved only for emergency C-sections.

    03:35 Typically with C-section again we use an epidural or we use spinal anesthesia.

    03:40 And even in some emerging cases we can still use epidural or spinal.

    03:45 However, if it is an extreme emergency situation we would need to do a C-section.

    03:51 General anesthesia is usually reserved for emergency sections or non-emergency sections where there is a contraindication to epidural or spinal anesthesia.

    04:00 Contraindications for spinal anesthesia include intracranial masses or a history of extensive back surgery.

    04:08 A lot of times moms can have vomiting and that can result in aspiration pneumonitis.

    04:12 Specially if mom has any food in her stomach or has not been in PO for 8 hours.

    04:19 Fetal side effects of general anesthesia, respiratory depression.

    About the Lecture

    The lecture Labor Stage 1: Obstetric Anesthesia by Veronica Gillispie, MD, FACOG is from the course Intrapartum Care. It contains the following chapters:

    • Obstetric Anesthesia
    • Regional Analgesia – Epidural and Spinal

    Included Quiz Questions

    1. Maternal nausea and lightheadedness
    2. Fetal respiratory depression
    3. Maternal hypotension
    4. Late decelerations on fetal heart tracing
    5. Uteroplacental insufficiency
    1. Hypotension
    2. Postpartum hemorrhage
    3. Fetal respiratory depression
    4. Maternal nausea and vomiting
    5. Maternal aspiration pneumonia
    1. Injection of analgesia directly into the spinal fluid for regional analgesia used during cesarean sections.
    2. Administration of a slow flow of analgesia via a catheter into the epidural space in the spine only used during cesarean sections.
    3. Administration of a slow flow of analgesia via a catheter into the epidural space in the spine which can be used during normal labor or cesarean sections.
    4. Administration of opiates into the pudendal nerve to create a local nerve block used in operative vaginal deliveries.
    5. Injection of analgesia directly into the spinal fluid for regional analgesia used during normal labor.

    Author of lecture Labor Stage 1: Obstetric Anesthesia

     Veronica Gillispie, MD, FACOG

    Veronica Gillispie, MD, FACOG

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