Review Note
Last Update: 03/07/2025 03:38 AM
Current Deck: ACG Part 2::Obstetrics
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Commit #296233
SS_OB 1.30 Evaluate the role of, options for and particular problems with providing general anaesthesia for elective and emergency caesarean birth
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Commit #296233Role of GA :
- Urgency
- Inadequate or failed regional
- Regional contraindicated
- Maternal decline
- Coagulation
- Spinal abnormalities
- Sepsis
- Expected high blood loss with abnormal placentation or uterine rupture
- Duration required as expected long surgical time (can consider CSE)
Problems :
- Increased risk of aspiration due to physiological changes of preganancy and gravid uterus -> RSI + antacid prophylaxis
- Difficult airway with increased prevalence of failed intubation 1 in 300
- FRC reduced 40%, increased O2 consumption
- Ventilation difficulties
- Fetal effects of GA medications and opioids - lower apgar at 1 and 5 mins common
- Increased awareness as per NAP 5
- Need to blunt sympathetic response to laryngoscopy in PET/ severe cardiac disease
- L lateral position to prevent aortocaval compression
- Decreases uterine tone
- Consider post-operative analgesia eg TAP blocks, local infiltration, IV PCA
- Increased blood loss compared to regional by 100-200ml
- Risk of thromboembolism
Anaesthetic techniques :
- Propofol + tiva
- Minimise tocolytic effect of volatile
- Assoc with poorer neonatal profile
- Shorter duration of amnesia
- Inhaled anaesthetic +N2O
- N2O used for MAC sparing and reduce volatiles effect on smooth muscle tone
- Mac decreased by up to 40% for pregnant patients
- Opiods
- Not traditionally part of induction due to neonatal respiratory depression often given after cord clamping
- Alfentanil 10mcg/kg or reminfentanil 1-2mcg/kg can be given to obtund hypertensive response to intubation in severe cardiac or hypertensive disorders
Awareness
- Increased incidence of awareness with thiopentone cf. propofol - may be due to similar appearance to antibiotics
- Rapidly increase end tidal volatile concentration
Waikato obstetric guidelines
NAP 5
Gold coast notes
Oxford handbook 5th edition