麻醉剖腹产.pptVIP

Anesthesia for C-sections Rachael E. Carpenter, DVM Cesarean Section Ideal protocol Ample analgesia, muscle relaxation and sedation for surgery without endangering mother or fetus Anesthetics, analgesics, sedatives, tranquilizers Cross blood-brain barrier Also cross placenta Cesarean Section C-sections are usually emergencies Physical condition of mother usually less than optimal Drugs should be chosen to minimize fetal depression Decrease time from induction to delivery Decreases fetal exposure to drugs Decreases maternal cardio/pul depression Pregnancy - CV Decreased peripheral vascular resistance (estrogens) leads to increased CO while BP remains the same Large uterus and dorsal recumbency can decrease venous return, CO, and uterine and renal blood flow Pregnancy - Pulmonary Oxygen consumption increases by 20% because of fetus, placenta, uterine muscle and mammary tissue FRC of lung decreases by anterior displacement of diaphragm and abdominal organs by gravid uterus So hypoventilation induces hypoxemia and hypercapnia more readily Pregnancy - GI LES tone decreased, more risk of regurgitation Therefore, also more risk of aspiration Since it is an emergency-patient may have been fed Pregnancy- Hepatic/Renal Overall liver function generally well maintained GFR increases by as much as 60%, so BUN and Cr should be lower than normal Increases in BUN and Cr may indicate significant renal pathology Anesthetic Techniques Regional Less neonatal depression Aspiration and airway problems General Speed and ease of induction Controllability Control of airway Anesthetic Techniques Epidural Systemic medications Line block Inhalant Neonatal Resucitation Clear head/oropharynx of fluid Suction Swinging/flinging Rub with towel and stimulate Keep warm Doxapram Intubate and ventilate PRN * * *