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1、Anesthesiafor cesareansectionTomArcher,MD,MBAUCSDAnesthesiaAuniquepsychosocialsurgeryOutlineC-section–auniquepsychosocialsurgeryHowtheOBanesthetistshouldbehave.EvolutionoftechniquesNeuraxialblockphysiologyandmanagementGAphysiologyandmanagement.ManagementofcommonproblemsC-s
2、ection–aunique psychosocialsurgeryPsychological/interpersonalaspectsUniquesurgery,happyeventgoneawry.Strikeabalancebetween“happyevent”and“riskysurgery”.Mostpatientsareawake–andwanttobe.Teamapproach(patient,family,nursing,OB,anesthesia)SupportpersonpresentinOR.Familymembers
3、inthelaborroom(facethem).Discretionaboutmedicalinfo–JW,druguse,previousabortions,etc.AnticipateandbeavailableKnoweverypatientonthefloor.Introduceyourselfearly.BeaccessibletoOBsandnurses.Getinformedearlyaboutpotentialproblems(airway,obesity,coagulopathyJW,congenitalheartdis
4、ease)Rememberthebasics(IVaccess,airway)AnticipateandbeavailableWeneedacertainknowledgeofOBtoknowwhatisgoingtohappen.Trytothinkoneortwostepsahead.“Placentaisn’toutyetinroom7”“Theladyin6hasaprettybadtear.”“Stripreviewin3,please.”“Wecan’tgetanIVontheladyin4.”“Canyougiveusawhi
5、ffofanesthesiain8?Wedon’tneedmuch.”EvolutionoftechniqueLast30years:decreasinguseofGA,nowabout5%ofcases.Was20-30%in70’satUCSD.Epiduralwas“alltherage”in70’sand80’s.SAB(orepidural)arenowpreferredanesthetics.AnesthesiaforC/S— basicinterventionsHappyevent(sortof)Gastricacidneut
6、ralizationLeftuterinedisplacementFluidloadingSupplementaloxygenSupportpersoninroom(regionalonly)AnesthesiaforC/S— ComplicationsSympathectomy/hypotensionNauseaBradycardiaHighspinal/respiratoryparalysisAspirationDifficultintubationLocalanesthetictoxicityFailedregionalanesthe
7、siaPersistentneurologicaldeficitC/Sredflags“Idon’tfeelsogood…IthinkI’mgoingtothrowup…”(Hypotensionuntilprovenotherwise).“Doc,IfeellikeI’mnotgettingenoughtobreathe…”The“floppyarmsign.”The“shakingheadsign.”Spinal--advantagesUniquelyappropriateinC/S(happyevent).Reallyamazingw
8、henyouthinkaboutit.Awakeandsmiling.Armsandhandsarenormal.Majorsurgeryinsidetheabdomen.Qui
