_in Obstetric Anesthesia UC San Diego 产科麻醉的并发症加州圣迭戈课件.ppt

Cited in Wong et al Vulnerable nerves in pelvis: Lateral femoral cutaneous (at inguinal ligament) Lumbosacral trunk Obturator Femoral Sciatic Safeguards to Minimize Peripheral Nerve Compression ?? Be watchful for patient positioning that contributes to nerve compression…????? Avoid prolonged use of the lithotomy position; regularly reduce hip flexion and abduction.???? Avoid prolonged positioning that may cause compression of the sciatic or peroneal nerve.??? F. Reynolds in Chestnut Safeguards to Minimize Peripheral Nerve Compression Place the hip wedge under the bony pelvis rather than the buttock.???? Use low-dose local anesthetic/opioid combinations during labor to minimize numbness and allow maximum mobility.????? Encourage the parturient to change position regularly.????? F. Reynolds in Chestnut Peripheral Neuropathy Syndromesin Obstetrics “Meralgia Paresthetica”– lateral femoral cutaneous nerve (pure sensory)– numbness of lateral thigh. Common in pregnancy. Femoral nerve damage from prolonged hip flexion? weak quadriceps. Can’t straighten leg and climb stairs. Peripheral Neuropathy Syndromesin Obstetrics Foot drop– Impaired foot dorsiflexion due to: Common peroneal nerve at fibula (leg holders) Lumbosacral trunk at pelvic brim (fetal head) Impaired dorsi- and plantar-flexion of foot and numbness below knee: Sciatic nerve damage. Pressure on buttock during long CS? Diabetic patient? Impaired adduction of thigh and inner thigh numbness– obturator palsy at pelvic brim The End Extra slides Spinal nerve “roots” are within the spinal canal. Dorsal root ganglion is at intervertebral foramen. * * * * High or Total Spinal A circulatory as well as respiratory emergency. You will have to assist or control ventilation. You must recognize situation immediately and act rapidly and with confidence so that patient does not panic (too much). High or Total Spinal Say three things: “You’re going to be OK.” “This happens sometimes when the sp