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Analgesia In Labour & For Cesarean

  1. Anesthetic of choice for IPV of second twin an+d replacement of an inverted uterus: Nitrous oxide
  2. Anesthetic gas which is used for analgesia in labor: Nitrous oxide (N2O).
    1. Injectables
      In pethidine 50 mg O2 inj. Promethazine 25 mg (Also Inj. Meperidine 50 mg
      1. Given IM at 2-4 hour Interval
      2. If neonate has acute respiratory distress due to the above drug’s- Give Inj Naloxone HCL in dose of 0.1 mg /kg of body weight
      3. Ketamine avoided in pregnant patients who are already hypertensive, as causes in B.P.
      4. Aspiration during general anesthesia causes Mendelson syndrome prevented by using precautions like:
        1. iKeep Pt. fasting 6-12 hours prior to anesthesia.
        2. Agents to reduce gastric acidity
        3. Skill full intubation while using cricoid pressure ( sellicks maneuver)
        4. After intubation, insertion of naso-qastric tube to empty the stomach.
        5. After completion of surgery extubate the pt. when she’s awake to make sure that her reflexes have returned
    2. Regional Anesthesia
      1. Aims at blocking sensory pathways.
      2. In early labour, pain is generated from the uterus. Pain is transmitted through the T 10, 11, 12 and L1 nerves (Predominantly T 11 & T 12).
      3. The motor pathways leave the cord at the level of T7 and T8 vertebrae. Hence a block above T10 
      4. level will cease off the pain, though permits motor action.
    3. Epidural analgesia
      1. Labour and vaginal delivery Requires blocking 10th thoracic to 5th sacral dermatome
      2. Labour abdominal delivery 8th thoracic to 1st sacral dermatome.
    4. Complications of an Epidural Anesthesia
      1. a. Immediate
        1. High or total spinal, Hypotension
        2. Most common S/E of epidural – hypotension .
        3. Urinary retention
        4. Headache
        5. Post-dural puncture seizures, Meningitis
        6. Cardiorespiratory arrest, Vestibulocochlear dysfunction
      2. Long-term
        1. (Epidural vs controls)
        2. Backache (19 vs 10%)
        3. Frequent headaches (4.6 vs 3%)
        4. Migraine headache (1.9 vs 1.1 %)
        5. Neckache (2.4 vs 1.6%)
        6. Tingling in hands or fingers (3 vs 2.2%)

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