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Obstetric Anaesthesia and Analgesia
Arun Kumar Paul
CHAPTER 1:
Physiological Considerations
GENITAL ORGANS
Haematological Changes
Blood Coagulation Factors
Heart and Circulation
Metabolic Changes
Gastrointestinal System
Hepatic Changes
Renal Changes
Nervous System
Pulmonary System
PHYSIOLOGY OF UTEROPLACENTAL CIRCULATION
Foetoplacental Circulation
PLACENTAL TRANSFER/EXCHANGE
Mechanism of Placental Transfer
Respiratory Gas Exchange
Maternal Protein Binding
Molecular Weight
Lipid Solubility
Degree of Ionisation
Concentration at Placental Site
Foetal Uptake and Distribution
Placental Drug Transfer
NORMAL LABOUR
Anaesthetic Implications
DIAGNOSIS OF PREGNANCY
Absolute Signs of Pregnancy
Assessment of Foetal Maturity
Foetal Monitoring During Labour (Reed, 1995)
Uterofoetal Resuscitation
CHAPTER 2:
Pharmacological Aspects
UTERINE STIMULANTS
ERGOT ALKALOIDS
Indications
Major Toxicity
Dose
Cautions
OXYTOCIN
Indications
Contraindications
Hazards
Doses
PROSTAGLANDINS
Uses
Side Effects
Dosage and Administration
UTERINE RELAXANTS (TOCOLYTICS)
Uses and Indications
Contraindications
Tocolytic Agents
β-2 AGONISTS
Side Effects
Cautions
Doses
MAGNESIUM SULPHATE
Side Effects
CALCIUM CHANNEL BLOCKERS
Side Effects
DRUGS INFLUENCING THE UTEROPLACENTAL BLOOD FLOW
Adverse Drug Reactions and Toxicity During Pregnancy
LOCAL ANAESTHETIC AGENTS
Side Effects
Systemic Toxicity
Features of Central Nervous System Toxicity
Features of Cardiovascular Toxicity
Prevention
Treatment
Neurotoxicity
Methaemoglobinaemia
Local Tissue Toxicity
Allergic Reactions
COMMONLY USED LOCAL ANAESTHETICS
Lignocaine
Prilocaine
Bupivacaine
Mepivacaine
INHALATIONAL ANAESTHETIC AGENTS
Nitrous Oxide
Halothane
Enflurane
Isoflurane
INTRAVENOUS ANAESTHETIC AGENTS
Thiopentone
Ketamine
Propofol
Midazolam
MUSCLE RELAXANTS
Suxamethonium
Tubocurarine
Gallamine
Pancuronium
Vecuronium
Atracurium
Mivacurium
Rocuronium
CHAPTER 3:
Pain Relief in Labour
PARACERVICAL BLOCK
Subarachnoid Block (Figs 3.4 and 3.5)
Disadvantages
LUMBAR EPIDURAL ANALGESIA
Contraindications
Complications
Special Indications
Caution
CAUDAL BLOCK (FIGS 3.6 TO 3.8)
Technique of Caudal Block
Indications
Contraindications
Complications
INTRASPINAL OPIOIDS
Side Effects
Disadvantages
PUDENDAL NERVE BLOCK (FIG. 3.9)
Transperineal Pudendal Nerve Block
Transvaginal Pudendal Nerve Block
Indications
Complications
CHAPTER 4:
Anaesthesia for Caesarean Section
CAESAREAN SECTION
Indications
Relative Indications
Types of Operation
GENERAL ANAESTHESIA
Practical Standard Technique of General Anaesthesia for Elective Caesarean Section
Advantages
Disadvantages
SPINAL ANAESTHESIA (FIGS 4.1 TO 4.3)
Advantages
Disadvantages
Management of Postspinal Headache
LUMBAR EPIDURAL ANAESTHESIA (FIGS 4.4 AND 4.5)
Advantages
Disadvantages
Indications of Epidural Block in Obstetrics
Technique
Contraindications
Complications
CHAPTER 5:
Neonatal Resuscitation
SOME NORMAL PHYSIOLOGICAL VALUES OF NEONATES
ASPHYXIA NEONATORUM
Salient Features
Evaluation of the Newborn
Management
Routine Measures for all Babies
RESUSCITATION
Neonates with Apgar Score 8 to 10
Neonates with Apgar Score 5 to 7
Neonates with Apgar Score 3 to 6
Neonates with Apgar Score 0 to 2
CHEST COMPRESSION (FIGS 5.1 AND 5.2)
RESPIRATORY RESUSCITATION (FIGS 5.3 TO 5.5)
Sizes of the Endotracheal Tube (Internal Diameter)
Preterm Baby Needs Special Consideration
CORRECTION OF HYPOVOLAEMIA
Monitoring
DRUG THERAPY
Complications
CHAPTER 6:
Some Anaesthetic Complications
ASPIRATION PNEUMONITIS
Predisposing Factors
Pathophysiology
Manifestations
Prevention
Treatment
TOTAL SPINAL ANAESTHESIA
Causes
Clinical Manifestations
Prevention
Management
Complications
Special Note
TOXICITY OF LOCAL ANAESTHETICS
Causes
Clinical Manifestations
Central Nervous System Features
Cardiovascular System Toxicity
Prevention
Treatment
Complications
PULMONARY EMBOLISM
Manifestations
Prevention
Treatment
Complications
HYPOTENSION DURING ANAESTHESIA
Manifestations
Dangers
Management
Prevention
Treatment
ANAPHYLACTIC SHOCK
Features
Management
Preventive Measures
Treatment
DIFFICULT TRACHEAL INTUBATION
Other Causes of Difficult Intubation
Management
Complications
Management of Inadvertent Oesophageal Intubation
CARDIAC ARREST
Types of Cardiac Arrest
Manifestations
Prevention
Management
BASIC LIFE SUPPORT (FIGS 6.1 AND 6.2)
Complications
CHAPTER 7:
Obstetric Complications
PREGNANCY INDUCED HYPERTENSION
Incidence
Predisposing Factors
Probable Aetiology
Pathophysiology of Pre-eclampsia
Manifestations
Complications
Causes of Maternal Death
Prognosis
Prevention
Management
Management of Anaesthesia
HAEMORRHAGE IN EARLY PREGNANCY
Spontaneous Abortion
Causes
General Measures
Active Treatment
Management
Anaesthetic Implications
Medical Termination of Pregnancy (MTP)
Anaesthetic Implications
Ectopic pregnancy
Differential Diagnosis
Management
ANTEPARTUM HAEMORRHAGE
Placenta Previa
Management
Abruptio Placentae
Management
Anaesthetic Implications
PRETERM LABOUR
Anaesthetic Implications
MULTIPLE PREGNANCY
Management
Anaesthetic Implications
POSTMATURITY
Management
Anaesthetic Implications
RUPTURE OF THE UTERUS
Management
Anaesthetic Implications
POSTPARTUM HAEMORRHAGE
Management
Retained Placenta
Causes
Dangers
Management
Anaesthetic Implications
Acute Inversion of Uterus
Causes
Dangers
Management
AMNIOTIC FLUID EMBOLISM
Management
Complications
UTERINE ATONY
Risk Factors
Manifestations
Obstetric Management
Anaesthetic Implications
CHAPTER 8:
Medical Diseases and Pregnancy
ANAEMIA IN PREGNANCY
Physiological Anaemia of Pregnancy
Iron Deficiency Anaemia
Clinical Manifestations
Haematological Findings
Biochemical Changes
Complications
Prophylactic Measures
Treatment
Parenteral Iron Therapy
Blood Transfusion
Care of the Anaemic Parturient in Labour
MEGALOBLASTIC ANAEMIA
Common Causes
Clinical Features
Haematological Findings
Biochemical Findings
Pathological Findings
Complications
Prophylaxis
Treatment
DIMORPHIC ANAEMIA
Prophylaxis
Curative Treatment
SICKLE CELL DISEASE
Diagnosis
Sickle Cell Disease and Pregnancy
Management
Complications
THALASSAEMIAS
Haematological Findings
Management
DISSEMINATED INTRAVASCULAR COAGULATION (DIC)
Causes of DIC
Laboratory Findings
Treatment
Anaesthetic Implications
HYPERTENSION DURING LABOUR
Complications
Anaesthetic Considerations
JAUNDICE IN PREGNANCY
Causes of Jaundice/Hepatic Dysfunction
Investigations/Liver Function Tests
VIRAL HEPATITIS
Hepatitis A
Hepatitis B
Manifestations of Acute Viral Hepatitis
Other Findings
Hazards
Prophylaxis
Management
DIABETES MELLITUS IN PREGNANCY
Classification
Manifestations
Diagnosis
Treatment
Preoperative Preparation
Management of Anaesthesia
Diabetes Mellitus in Pregnancy
HYPERTHYROIDISM AND PREGNANCY
Thyroid Function Tests
In Hyperthyroidism
Treatment
Anaesthetic Management in Patients with Hyperthyroidism
Pregnancy
Features
Management
Thyroid Crisis/Storm
Precipitating Factors
Manifestations
Treatment
HYPOTHYROIDISM AND PREGNANCY
Manifestations
Treatment
Management of Anaesthesia
EPILEPSY IN PREGNANCY
Types
Management
Anaesthetic Management
MYASTHENIA GRAVIS
Common Features
Diagnosis
Treatment
Management of Anaesthesia
Myasthenia Gravis and Pregnancy
AIDS IN PREGNANCY
Manifestations
Management of Anaesthesia
MALIGNANT HYPERTHERMIA
Manifestations
Diagnosis
Management
Anaesthetic Management
PHAEOCHROMOCYTOMA
Manifestations
Diagnosis
Treatment
Anaesthetic Management
Pregnancy and Phaeochromocytoma
RESPIRATORY DISEASES AND PREGNANCY
Chronic Obstructive Pulmonary Disease (COPD)
Features of Chronic Bronchitis
Features of Lung Emphysema
Diagnosis
Management
Anaesthetic Management
BRONCHIAL ASTHMA
Manifestations
Investigations
Management
Anaesthetic Management
CARDIAC DISEASE AND PREGNANCY
Diagnosis
Effects of Heart Diseases on Pregnancy
Prognosis
Management
Anaesthetic Management
Management of Pulmonary Oedema
CHAPTER 9:
Miscellaneous
NONOBSTETRIC SURGERY DURING PREGNANCY
ANAESTHESIA
POSTPARTUM TUBAL LIGATION
LAPAROSCOPIC STERILISATION
Advantages
Disadvantages
BREECH PRESENTATION
Maternal Risks
Foetal Dangers
Prevention of Foetal Problems
External Cephalic Version
Anaesthetic Implications
DILATATION AND EVACUATION (D AND E)
Indications
Anaesthesia
Dangers
SUCTION EVACUATION
Indications
Anaesthesia
Complications
HYSTEROTOMY
Indications
Anaesthesia
Complications
EPISIOTOMY
Indications
Advantages
Timing
Types
Anaesthetic Implications
FORCEPS OPERATION/DELIVERY
Indications of Forceps Delivery
Lumbar Epidural Block
Caudal Block
Subarachnoid Block
Pudendal Block and Local Infiltration
General Anaesthesia
VACUUM EXTRACTION
Indications
Advantages
Disadvantages
Contraindications
Anaesthesia
Complications
BIBLIOGRAPHY
INDEX
TOC
Index
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