Anesthesia for cesarean sectionppt：sectionppt麻醉对剖宫产.ppt

Anesthesia for cesarean section Tom Archer, MD, MBA UCSD Anesthesia Outline C-section – a unique psychosocial surgery How the OB anesthetist should behave. Evolution of techniques Neuraxial block physiology and management GA physiology and management. Management of common problems C-section – a unique psychosocial surgery Psychological / interpersonal aspects Unique surgery, happy event gone awry. Strike a balance between “happy event” and “risky surgery”. Most patients are awake– and want to be. Team approach (patient, family, nursing, OB, anesthesia) Support person present in OR. Family members in the labor room (face them). Discretion about medical info– JW, drug use, previous abortions, etc. Anticipate and be available Know every patient on the floor. Introduce yourself early. Be accessible to OBs and nurses. Get informed early about potential problems (airway, obesity, coagulopathy JW, congenital heart disease) Remember the basics (IV access, airway) Anticipate and be available We need a certain knowledge of OB to know what is going to happen. Try to think one or two steps ahead. “Placenta isn’t out yet in room 7” “The lady in 6 has a pretty bad tear.” “Strip review in 3, please.” “We can’t get an IV on the lady in 4.” “Can you give us a whiff of anesthesia in 8? We don’t need much.” Evolution of technique Last 30 years: decreasing use of GA, now about 5% of cases. Was 20-30% in 70’s at UCSD. Epidural was “all the rage” in 70’s and 80’s. SAB (or epidural) are now preferred anesthetics. Anesthesia for C/S—basic interventions Happy event (sort of) Gastric acid neutralization Left uterine displacement Fluid loading Supplemental oxygen Support person in room (regional only) Anesthesia for C/S—Complications Sympathectomy / hypotension Nausea Bradycardia High spinal / respiratory paralysis Aspiration Difficult intubation Local anesthetic toxicity Failed regional anesthesia Persistent neurological deficit C/S red flags “I don’t feel so good…I thin