产科麻醉.pptVIP

Obstetric Anesthesia Department of anesthesiology Cui Xiao Guang PHYSIOLOGIC CHANGES OF PREGNANCY 1 Cardiovascular System : cardiac output , heart rate Hematologic System : blood volume increases by up to 45% , red cell volume increases by only 30% -- physiologic anemia Respiratory System : increase in the respiratory minute volume and work of breathing Gastrointestinal System : risk of incidence of aspiration↑ endotracheal intubation: the risk Renal System : GFR rises 50% ; glycosuria Central Nervous System :↑?sensitivity to anesthetics. PLACENTAL TRANSFER OF ANESTHETIC DRUGS Placenta transport : Simple diffusion Facilitated diffusion Active transport Pinocytosis Readily cross : low molecular weights, high lipid solubility , non-ionized Approximately 50% of the umbilical venous blood bypasses the liver. Morphine Placental transfer is rapid Mother: uterus reactiveness↓ orthostatic hypotension nausea vomiting delayed gastric emptying Fetus: respiratory depression Pethidine Most commonly used during labor intramuscular dose : 50 -100 mg Time of IM: before expulsion 1 h or 4 h uterine contraction, frequency and intension ↑ Fentanyl Alfentanil Sufentanil Placental transfer is rapid??? Low dose: 10 -25 μg fentanyl or 5-10 μg sufentanil in subarachnoid space PCEA: low dose of fentanyl and 0.1%- 0.3% ropivacaine Tramadol Placental transfer No inhibiting uterine contraction No Respiratory depression Diazepam Readily cross the placenta Half-lives: 48 hours Problems: sedation, hypotonia, cyanosis, impaired metabolic responses to stress. Midazolam Plasma protein binding: 94% Respiratory depression: depended on dose 0.075 mg/kg – no problem 0.15 mg/kg – different degree Chlorderazin Preeclampsia and eclampsia IM：12.5 – 25 mg Over