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Chapter: Clinical Anesthesiology: Anesthetic Management: Obstetric Anesthesia

General Approach to the Obstetric Patient

All patients entering the obstetric suite potentially require anesthesia services, whether planned or emergent.

General Approach to the Obstetric Patient

 

All patients entering the obstetric suite potentially require anesthesia services, whether planned or emergent. Patients requiring anesthetic care for labor or cesarean section should undergo a focused preanesthetic evaluation as early as pos-sible. This should consist of a maternal health his-tory, anesthesia and anesthesia-related obstetric history, blood pressure measurement, airway assessment, and back examination for regional anesthesia.Regardless of the time of last oral intake, all patients are considered to have a full stomachand to be at risk for pulmonary aspiration. Because the duration of labor is often prolonged, guidelines usually allow small amounts of oral clear liquid for uncomplicated labor. The minimum fasting period for elective cesarean section remains controver-sial, but is recommended to be 6 h for light meals and 8 h for heavy meals. Prophylactic administra-tion of a clear antacid (15–30 mL of 0.3 M sodium citrate orally) every 30 min prior to a cesarean section can help maintain gastric pH greater than 2.5 and may decrease the likelihood of severe aspi-ration pneumonitis. An H2-blocking drug (raniti-dine, 100–150 mg orally or 50 mg intravenously) or metoclopramide, 10 mg orally or intravenously, should also be considered in high-risk patients and in those expected to receive general anesthe-sia. H2 blockers reduce both gastric volume and pH but have no effect on the gastric contents already present. Metoclopramide accelerates gastric emp-tying, decreases gastric volume, and increases lower esophageal sphincter tone. The supine posi-tion should be avoided unless a left uterine dis-placement device (>15° wedge) is placed under the right hip.

 

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Clinical Anesthesiology: Anesthetic Management: Obstetric Anesthesia : General Approach to the Obstetric Patient |


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