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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