1、Obstetric Anesthesia Respiratory System:increase in the respiratory minute volume and work of breathingGastrointestinal System:risk of incidence of aspirationendotracheal intubation Renal System:GFR rises 50%;glycosuriaCentral Nervous System:sensitivity to anesthetics.Respiratory SystemlO2(Consumpti
2、on 消耗)+20 to+50%lMV(Minute Ventilation分钟通气量)+50%lTV +40%lPaO2 +10%lPaCO2 -15%lHCO3 -15%lFRC -20%Placenta transport:Simple diffusion Facilitated diffusion Active transport PinocytosisReadily cross:low molecular weights,high lipid solubility,non-ionized Approximately 50%of the umbilical venous blood b
3、ypasses the liver.lNarcotic analgesic morphine pethidine fentanyl alfentanil sufentanil lGeneral anesthetics propofol l吗啡、哌替啶、芬太尼Placental transfer is rapidMother:uterus reactiveness orthostatic hypotension nausea vomiting delayed gastric emptyingFetus:respiratory depressionMost commonly used during
4、 labor intramuscular dose:50-100 mg Time of IM:before expulsion 1 h or 4 huterine contraction,frequency and intension Placental transfer is rapid Low dose:10-25 g fentanyl or 5-10 g sufentanil in subarachnoid space PCEA:low dose of fentanyl and 0.1%-0.3%ropivacaine Placental transfer No inhibiting u
5、terine contraction No Respiratory depression Readily cross the placenta Half-lives:48 hours Problems:sedation,hypotonia,cyanosis,impaired metabolic responses to stress.Plasma protein binding:94%Respiratory depression:depended on dose 0.075 mg/kg no problem 0.15 mg/kg different degree Pregnant woman:
6、慎用Apgar score Neonatus sleep:little Premature and intrauterine embarrass:carefully usingHigh doses(greater than 2 mg/kg)may cause low Apgar scores and abnormalities in neonatal muscle toneLabor pains of uterine contractionUterine muscular tension and contraction forceContraindication:psychosis,gesta
7、tional hypertension syndrome or preeclampsia,metrorrhexis Recommendation:induction:2.5 mg/kg maintenance:2.5-5.0 mg/kg/h Discontinue gravidity only Placental transfer is rapid Mothers respiration,circulation and Uterine muscular contraction force 20-30s before of first stage of labor:50%O2 and 50%N2
8、O,maximumhalothane Cholinesterase:normal doseno placental transfer Dose 300 mg or single dose is larger:still have placental transfer Onset is quick,maintanence is short and placental transfer is leastAtracurium:0.3 mg/kgFactors:Protein binding:Molecular weightLiposolubility Catabolism in the placen
9、t Procaine Lidocaine Bupivacaine RopivacaineChoice depends on:the indications for the surgery the degree of urgency maternal status desires of the patient Hyperbaric bupivacaine Advantages:rapid onset,little risk of local anesthetic toxicity,minimal transfer to the fetus,infrequent failure.Disadvant
10、ages:finite duration hypotension headache L 23 or L 12 1.5%2%Lidocaine or 0.5%Ropivacaine emergency cesarean section Increased dramatically in popularity Advantages:rapid onset supplemented at any time anesthetic dose sacral nerves block is sufficient rapid induction:obviate positive pressure ventil
11、ation oppress the cricoid cartilage mainterance:light anesthesia vomiting,backstreaming and aspiration:atropine,0.5 mg,IM or glycopyrolate,0.2 mg,IM Incidence:2%30%Time:after 28 weeks,specially 3236 weeks Symptoms:hypotension,dizziness,nausea,chest distress,cold sweat,to yawn,pulse rate,pallescence
12、Emergency operation:late trimester of pregnancy:hemorrhage gestational hypertension syndrom and eclampsia Selective operation:hypertension cardiac disease diabetes multifetation Preanesthtic preparation:blood coagulation function DIC sifting test acute renal failure Principle:general anesthesia:acti
13、ve bleeding,hypovolemic shock,definite blood coagulation disfunction or DIC intraspinal anesthesia:condition of mother and fetus is okay Managementdegrees of abruptio placentae.A,Concealed hemorrhage.B,External hemorrhage.C,Complete placental separation.Types of placenta previa.Announcements of the
14、induction:difficult airway cricoid cartilage backstreaming and aspiration Prepare to salvage the blood coagulation disfunction and the hemorrhoea.Prevent the acute renal function failure:urine volume urea nitrogen and creatinine Prevention and cure of DIC Incidence:10.3%Cause of death:cerebrovascula
15、r accident,pneumonedema,liver necrosis Pathophysiology:systemic arteriola systole,fetus Management:cardiac failure cerebral hemorrhage placental abruption blood coagulation disfunction haematolysis hepatic enzyme thrombocytopenia acute renal failure trying stable anesthesia:stress reaction:fentanyl
16、avoid to use ketamine SBP:140150 mmHg,DBP:about 90 mmHg ganglioplegic or nitroglycerin maintain heart,kindey and lung function:treatment of complication:basic monitoring:ECG SpO2 NIBP CVP urine volume blood gas analysis prepare to salvage the neonatal asphyxia ICU postoperation analgesia pathophysio
17、logy:abdominal aorta and inferior vena cava compression;fetal lung maturity;incidence of postpartum hemorrhage.anesthesia:epidural anesthesia management:addition of volume:colloid oxygen,prevention and cure of Supine hypotensive syndrome preparation of resuscitation of newborn Apgar score is a simpl
18、e,useful guide -The Apgar scoring system Score*Sign 0 1 2 Heart rate Absent Less than 100/min More than 100/min Respiratory effort Absent Slow,irregular Good,crying Color Blue,pale Body pink,extre mities blue(acrocyanosis)Completely pink Reflex irritability(response to insertion of a nasal catheter)
19、Absent Grimace Cough,sneeze Muscle tone Limp Some flexion of extremities Active motion 1-minute score -degree of asphyxia 5-minute score-prognosis evaluated at 1 and 5 minutes.should not wait until 1 minute has passed before initiating resuscitation.normal:7-10 mild asphyxia:4-6 severe asphyxia:0-3
20、A(Airway)B(Breathing)C(Circulation)D(Drug)E(Evaluation)Incubation:2731 Position:Suctioning:mouth and nose Stimulate:Complete it within 20s Evaluation:according to breath,heart rate and skin colour Normal:stop resuscitation No spontaneously brathing,HR100/min:bag respirator HR80/min:closed cardiac ma
21、ssage;tracheal intubation,medication Maniphalanx pressurize Tidal volume:2040ml I:E=1.5:1 RP:3040/min first twice:pressure 3040 cmH2O subsequently:pressure 1020 cmH2OHR:120/minDepth:12cm 30s after the closed cardiac massage,still cant recovery:drug Epinephrine:0.10.2mg/kg,intratracheal drop in umbil
22、ical cord was clamped and cut earlier intrauterine asphyxia placental abruption hemorrhage too much:antepartum or intrapartum arterial blood pressure and CVP pale skin poor capillary refill extremities are cold pulses are weak or absent intravascular volume expansion blood,plasma,crystalloid,Albumin
23、 10 mL/kg of normal saline,1 to 2 g/kg of 25%albumin,or 10 mL/kg of plasma.Care must be taken Respiratory acidosis is corrected by controlling ventilationMetabolic acidosis is corrected by infusing sodium bicarbonate.Requisite amount of sodium bicarbonate(mmol):=0.6BW(kg)(normal BE-present BE)/4 sod
24、ium bicarbonate 1 mmol/kg/minSodium bicarbonate should not be infused unless ventilation is adequate.temperature breath heart rate blood pressure urine volume Special position:head down and lithotomy position Old age:comorbidities Emergency case:exfetation,ovarian cyst intortion,perineal position trauma,uterine perforation More other:selective operation Hysteroscope and Laparoscopic Surgery:
