Chestnut’s Obstetric Anesthesia: Principles and Practice

Description

Comprehensive, user-friendly, and up to date, Chestnut's Obstetric Anesthesia: Principles and Practice, 6th Edition, provides the authoritative clinical information you need to provide optimal care to your patients. This substantially revised edition keeps you current on everything from basic science to anesthesia techniques to complications, including coverage of new research that is paving the way for improved patient outcomes. An expert editorial team ensures that this edition remains a must-have resource for obstetric anesthesiologists and obstetricians, nurse anesthetists and anesthesiology assistants, and anesthesiology and obstetric residents and students. Key Features Presents the latest information on anesthesia techniques for labor and delivery and medical disorders that occur during pregnancy, emphasizing the treatment of the fetus and the mother as separate patients with distinct needs. Contains new chapters on shared decision-making in obstetric anesthesia and chronic pain during and after pregnancy. Features extensive revisions from cover to cover, including consolidated information on maternal infection and postoperative analgesia. Covers key topics such as neonatal assessment and resuscitation, pharmacology during pregnancy and lactation, use of nitrous oxide for labor analgesia, programmed intermittent epidural bolus (PIEB) technique, epidural analgesia-associated fever, the role of gastric ultrasonography to assess the risk of aspiration, sugammadex in obstetric anesthesia, the role of video laryngoscopy and new supraglottic airway devices, spinal dysraphism, and cardiac arrest in obstetric patients. Incorporates the latest guidelines on congenital heart disease and the management of sepsis, as well as difficult airway guidelines that are specific to obstetric anesthesia practice. Offers abundant figures, tables, and boxes that illustrate the step-by-step management of a full range of clinical scenarios. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices. Cover......Page 1 Chestnut's Obstetric Anesthesia......Page 2 Medical Objections to the Use of Ether for Childbirth......Page 3 Opioids and Obstetrics......Page 5 The Effects of Anesthesia on the Newborn......Page 6 The Effects of Anesthesia on Labor......Page 8 Some Lessons......Page 10 References......Page 11 Physical Examination and Cardiac Studies......Page 13 Central Hemodynamics......Page 14 Aortocaval Compression......Page 16 Airflow Mechanics......Page 17 Ventilation and Blood Gases......Page 18 Gastrointestinal Motility......Page 20 The Kidneys......Page 21 Blood Volume......Page 22 Coagulation......Page 23 Hematology and Coagulation during the Puerperium......Page 24 Adrenal Cortical Function......Page 25 Sleep......Page 26 Blood Replacement......Page 27 Intravenous and Inhalation Anesthetics......Page 28 Local Anesthetic Dose Requirement......Page 29 Key Points......Page 30 References......Page 31 Anatomy and Structure......Page 38 Pregnancy-Induced Changes......Page 39 Autoregulation......Page 40 Vascular Changes during Pregnancy......Page 41 Steroid Hormones......Page 42 Shear Stress......Page 43 Methods of Measurement of Uteroplacental Blood Flow......Page 44 Vasopressors......Page 46 Epinephrine and α2-Adrenergic Agonists......Page 47 Antihypertensive Agents......Page 48 Oxygen Therapy......Page 49 References......Page 50 Embryology......Page 56 Fetal......Page 58 Passive Transport......Page 60 Oxygen......Page 61 Pharmacokinetic Principles......Page 63 Propofol......Page 64 Opioids......Page 66 Antihypertensive Agents......Page 67 Anticoagulants......Page 68 Infection and Inflammation......Page 69 References......Page 70 Amniotic Fluid......Page 77 Oxygen Supply and Transport......Page 78 Glucose and Lactate Metabolism......Page 79 Thermoregulation......Page 80 Blood Volume......Page 81 Cardiac Output and Distribution......Page 82 Regulation of Fetal Circulation......Page 83 Fetal Pulmonary System......Page 84 Fetal Hematologic System......Page 85 Swallowing......Page 86 Structural and Functional Brain Development......Page 87 Nociception......Page 88 Key Points......Page 89 References......Page 90 Determination of Gestational Age......Page 96 Routine Ultrasonography......Page 97 Evaluation of Fetal Growth......Page 98 Fetal Growth Restriction......Page 99 Assessment of Fetal Well-Being......Page 100 Nonstress Test......Page 101 Biophysical Profile......Page 104 Contraction Stress Test......Page 106 Doppler Velocimetry......Page 107 Perinatal Ultrasonography......Page 109 Fetal Aneuploidy Screening......Page 110 Ultrasonographic Screening for Fetal Aneuploidy......Page 112 Definitive Diagnosis of Fetal Chromosomal Abnormalities......Page 113 Chorionic Villus Sampling......Page 114 Three-Dimensional Ultrasonography......Page 115 Fetal Cells or DNA in the Maternal Circulation......Page 116 Abnormal Serum Analyte and Nuchal Translucency Screening with Normal Fetal Karyotype......Page 117 Hydrops Fetalis......Page 118 Postterm Pregnancy......Page 119 Intrauterine Fetal Demise......Page 120 Fetal Therapy......Page 121 Antenatal Corticosteroids......Page 122 Key Points......Page 123 References......Page 124 Chapter Outline......Page 131 Obstructive Uropathy......Page 133 Congenital Diaphragmatic Hernia......Page 134 Sacrococcygeal Teratoma......Page 136 Myelomeningocele......Page 137 Twin-to-Twin Transfusion Syndrome......Page 138 Congenital Heart Defects......Page 141 Anesthetic Management......Page 142 Anesthesia for Open Fetal Surgery......Page 143 Anesthesia for the Ex Utero Intrapartum Treatment Procedure......Page 145 Fetal Response to Surgical Stimulation......Page 146 Effects of Anesthesia on the Fetus......Page 147 The Future of Fetal Therapy......Page 148 References......Page 149 Fetal Risk during Labor......Page 154 Electronic Fetal Heart Rate Monitoring......Page 155 Fetal Heart Rate Variability......Page 156 Accelerations......Page 157 Limitations of Electronic Fetal Heart Rate Monitoring......Page 159 Supplemental Methods of Fetal Assessment......Page 161 Additional Technologies for Fetal Assessment......Page 162 Intrapartum Fetal Therapy......Page 163 References......Page 165 Circulation......Page 170 Thermal Regulation......Page 172 Antenatal Assessment......Page 173 Apgar Score......Page 174 Umbilical Cord Blood Gas and pH Analysis......Page 175 Respiration and Circulation......Page 177 Neonatal Resuscitation......Page 178 Meconium-Stained Amniotic Fluid......Page 183 Preterm Infant......Page 184 Congenital Anomalies......Page 185 Ethical Considerations......Page 187 Neurobehavioral Testing......Page 188 Key Points......Page 190 References......Page 191 Fetal Brain Development......Page 198 History, Definitions, and Significance......Page 200 Epidemiology and Etiology......Page 201 Peripartum Asphyxia and Cerebral Palsy......Page 202 Chorioamnionitis, Fever, and Cerebral Palsy......Page 203 Maternal Inflammation and Fetal Brain Injury......Page 204 Animal Models of Fetal Asphyxia......Page 205 Neuropathology of Fetal Asphyxia......Page 207 Fetal Adaptive Responses......Page 208 Opioids......Page 209 Maternal Anesthesia and the Fetal Brain......Page 210 Role of the Placenta......Page 212 Hypothermia......Page 213 Experimental Neuroprotection......Page 214 References......Page 215 The Swiss Cheese Model......Page 222 Medical Errors......Page 223 Teams and Teamwork......Page 225 High-Reliability Organizations and Teams......Page 226 Team Training......Page 227 Simulation-Based Training in Obstetrics......Page 228 Crew Resource Management......Page 230 Options for Simulator Training in Obstetrics......Page 231 References......Page 232 The Spinal Cord, Spinal Canal, and Meninges......Page 236 The Vertebral Column and Ligaments......Page 237 Anatomic Changes of Pregnancy......Page 238 Obstetric Pain Pathways......Page 239 Monitoring......Page 240 Patient Positioning......Page 241 Aseptic Technique......Page 242 Spinal Anesthesia......Page 243 Epidural Anesthesia......Page 247 Combined Spinal-Epidural Anesthesia......Page 249 Dural-Puncture Epidural Anesthesia......Page 251 Ultrasonographic Guidance......Page 252 Intravascular Test Dose......Page 256 Intrathecal Test Dose......Page 258 Spinal Anesthesia......Page 259 Unintentional Dural Puncture......Page 260 Unintentional Intravascular or Subarachnoid Injection......Page 261 Inadequate Anesthesia......Page 262 Teaching Neuraxial Anesthesia Procedures......Page 263 References......Page 264 Chirality......Page 269 Mechanism of Action......Page 270 Lidocaine......Page 271 Effect of Histamine (H2)-Receptor Antagonists......Page 272 Central Nervous System Toxicity......Page 273 Central nervous system toxicity.......Page 274 Treatment of Systemic Toxicity......Page 275 Tissue Toxicity......Page 276 Allergic Reactions......Page 277 Uterine Blood Flow......Page 278 Umbilical Blood Flow......Page 279 Placental Transfer......Page 280 Protein Binding......Page 281 Teratogenicity......Page 282 Fetal Heart Rate......Page 283 Opioids......Page 284 Molecular Structure......Page 285 Mechanism of Action......Page 286 Pharmacokinetics and Pharmacodynamics......Page 287 Pharmacogenetics......Page 289 Side Effects......Page 290 Nausea and Vomiting......Page 291 Respiratory Depression......Page 292 Recrudescence of Herpes Simplex Virus Infections......Page 294 Fetal Heart Rate Abnormalities......Page 295 Epinephrine......Page 296 Clonidine......Page 297 Key Points......Page 298 References......Page 299 Chapter Outline......Page 310 Distribution.......Page 311 General Anesthesia......Page 312 General Principles and Teratology......Page 314 U.S. Food and Drug Administration Categories......Page 316 Anticonvulsants......Page 317 Psychotropic Drugs......Page 318 Anticoagulants......Page 319 Drugs for Treatment and Prophylaxis of Viral Infections......Page 320 Drug Use During Lactation......Page 321 Transfer of Drugs to Breast Milk......Page 322 Analgesics......Page 323 Cardiovascular Drugs......Page 324 Antidiabetic Drugs......Page 325 Cannabis......Page 326 References......Page 327 Hormonal Stimulation......Page 333 In vitro Fertilization......Page 334 Zygote Intrafallopian Transfer......Page 335 Obstetric Complications......Page 336 General Considerations......Page 337 Opioids and Benzodiazepines......Page 338 Volatile Halogenated Agents......Page 339 Anesthetic Management......Page 340 Pneumoperitoneum and the Trendelenburg Position......Page 341 Laparoscopic-Assisted Reproductive Technology......Page 342 Key Points......Page 343 References......Page 344 Cardiovascular System......Page 347 Ectopic Pregnancy......Page 348 Diagnosis......Page 349 Obstetric Management......Page 350 Anesthetic Management......Page 351 Early Pregnancy Loss, Abortion, and Intrauterine Fetal Demise......Page 352 Obstetric Complications......Page 353 Anesthetic Management......Page 354 Obstetric Management......Page 355 Anesthetic Management......Page 356 Gestational Trophoblastic Disease......Page 357 Categorization and Etiology......Page 358 Medical Complications......Page 359 Anesthetic Management......Page 360 Key Points......Page 361 References......Page 362 Chapter Outline......Page 365 Cardiovascular System Changes......Page 366 Risk for Teratogenicity......Page 367 Principles of Teratogenicity......Page 368 Derangements of normal physiology.......Page 369 Diagnostic procedures.......Page 370 Animal studies.......Page 371 Animal studies.......Page 372 Occupational exposure to waste anesthetic agents.......Page 373 Studies of operations performed during pregnancy.......Page 374 Behavioral Teratology......Page 375 Maternal and fetal oxygenation.......Page 376 Uteroplacental perfusion.......Page 377 Systemic Agent Effects on the Fetus......Page 378 Emergency Abdominal Surgery......Page 379 Laparoscopy......Page 380 Anesthetic Technique......Page 382 References......Page 383 Primary Cesarean Delivery: Choice of Uterine Incision......Page 405 Stages of Labor......Page 389 The Passageway......Page 390 The Mechanism of Labor......Page 391 Admission......Page 392 Labor Progress: The Labor Curve......Page 393 Second Stage of Labor......Page 395 Third Stage of Labor......Page 396 Labor Progress: Five Management Questions......Page 397 Preterm Premature Rupture of Membranes......Page 398 Elective Induction......Page 399 Vertex Presentation......Page 400 Shoulder Dystocia......Page 401 References......Page 402 Maternal Outcomes......Page 407 History of More Than One Cesarean Delivery......Page 408 Suspected Macrosomia......Page 409 Social and Economic Factors......Page 410 Professional Society Practice Guidelines......Page 411 Anesthetic Management......Page 413 References......Page 415 Measurement and Severity of Labor Pain......Page 418 Personal Significance and Meaning......Page 420 First Stage of Labor......Page 421 Peripheral Afferent Terminals......Page 422 Role of Sensitization......Page 424 Peripheral Nerve Axons......Page 425 Spinal Cord......Page 426 Obstetric Course......Page 428 Cardiac, Respiratory, and Gastrointestinal Effects......Page 429 Pain after Delivery......Page 430 Summary......Page 431 References......Page 432 Pain Perception......Page 437 History......Page 438 Limitations......Page 439 Nonpharmacologic Analgesic Techniques......Page 440 Touch and Massage......Page 441 Vertical Position......Page 442 Acupuncture/Acupressure......Page 443 Implications for Anesthesia Providers......Page 444 References......Page 445 Parenteral Opioid Analgesia......Page 449 Meperidine......Page 451 Fentanyl......Page 452 Nalbuphine......Page 453 Pentazocine......Page 454 Patient-Controlled Analgesia......Page 455 Fentanyl......Page 456 Remifentanil versus Meperidine.......Page 457 Efficacy and Optimal Regimen......Page 460 Side Effects......Page 461 Opioid Adjuncts and Sedatives......Page 462 Nitrous Oxide......Page 463 Isoflurane......Page 464 References......Page 465 Chapter Outline......Page 470 Indications and Contraindications......Page 471 Epidural Analgesia......Page 472 Combined Spinal-Epidural Analgesia......Page 473 Equipment and Monitors......Page 474 Epidural Test Dose......Page 475 Bupivacaine.......Page 476 Ropivacaine.......Page 477 Lipid-soluble opioids: fentanyl and sufentanil.......Page 478 Epinephrine.......Page 481 Neostigmine.......Page 482 Fentanyl and sufentanil.......Page 483 Other opioids.......Page 484 Baricity of the intrathecal solution.......Page 485 Drugs for the Maintenance of Epidural Analgesia......Page 486 Continuous infusion.......Page 487 Patient-controlled epidural analgesia.......Page 488 Programmed intermittent epidural bolus injection.......Page 489 Equipment......Page 490 Spinal Analgesia......Page 491 Ambulatory “Walking” Neuraxial Analgesia......Page 492 Analgesia/Anesthesia for Vaginal Delivery......Page 493 Pruritus......Page 494 Fever......Page 495 Delayed Gastric Emptying......Page 497 Inadequate Analgesia......Page 498 Unintentional Dural Puncture......Page 499 Intravascular Injection of Local Anesthetic......Page 500 High Neuroblockade and Total Spinal Anesthesia......Page 501 Extensive Motor Blockade......Page 502 Pelvic Floor Injury......Page 503 Effects of Neuraxial Analgesia on the Progress of Labor......Page 504 Randomized Controlled Trials......Page 505 Mode and density of neuraxial analgesia and effect on cesarean delivery rate.......Page 506 Impact Studies......Page 507 Timing of Initiation of Neuraxial Analgesia......Page 508 Instrumental Vaginal Delivery Rate......Page 509 First Stage of Labor......Page 512 Second Stage of Labor......Page 514 Third Stage......Page 515 Fetal Heart Rate......Page 516 Indirect Effects......Page 517 Initiation of Analgesia......Page 518 References......Page 520 Paracervical Block......Page 536 Technique......Page 537 Maternal Complications......Page 538 Direct fetal central nervous system and myocardial depression.......Page 539 Summary......Page 540 Lumbar Sympathetic Block......Page 541 Pudendal Nerve Block......Page 542 Technique......Page 543 Perineal Infiltration......Page 544 Key Points......Page 545 References......Page 546 Surgical Considerations......Page 549 Nonmedical Issues......Page 550 Gastric Emptying......Page 551 Summary of Aspiration Risk......Page 553 Local Anesthesia......Page 554 General Anesthesia......Page 555 Spinal Anesthesia......Page 557 Postoperative Analgesia......Page 559 References......Page 560 History......Page 563 Operative Technique......Page 564 Prevention of Cesarean Delivery......Page 565 Blood Products......Page 566 Monitoring......Page 567 Equipment......Page 568 Prophylactic Antibiotics......Page 569 Supplemental Medications for Anxiety......Page 570 Positioning......Page 571 Supplemental Oxygen......Page 572 Neuraxial versus General Anesthesia......Page 573 Overview of Neuraxial Anesthetic Techniques......Page 576 Local Anesthetic Agents......Page 577 Adjuvant Agents......Page 578 Epidural Anesthesia......Page 580 Adjuvant Agents......Page 581 Combined Spinal-Epidural Anesthesia......Page 582 Extension of Epidural Labor Analgesia......Page 583 General Anesthesia......Page 584 Preparation......Page 585 Induction......Page 586 Maintenance......Page 587 Propofol.......Page 588 Etomidate.......Page 589 Nitrous oxide.......Page 590 Local Anesthesia......Page 591 Recovery From Anesthesia......Page 592 Awareness and Recall......Page 593 Risk Factors for Hypotension......Page 594 Prevention of Hypotension......Page 595 Treatment of Hypotension......Page 596 Failure of Neuraxial Blockade......Page 597 Nausea and Vomiting......Page 598 Postoperative Nausea and Vomiting......Page 599 Prophylaxis and Treatment of Nausea and Vomiting......Page 600 Perioperative Pain......Page 601 Pruritus......Page 602 Postpartum Hemorrhage......Page 603 Response to Blood Loss......Page 605 Obstetric Hysterectomy......Page 606 Key Points......Page 607 References......Page 608 Opioid Analgesia......Page 622 Intravenous Patient-Controlled Analgesia......Page 623 Infusion Pump Settings......Page 624 Acetaminophen......Page 625 Nonsteroidal Antiinflammatory Drugs......Page 626 Gabapentin......Page 627 Efficacy and Benefits of Neuraxial Analgesia......Page 628 Central Nervous System Penetration......Page 629 Onset and duration.......Page 630 Single-dose epidural regimens to optimize postcesarean analgesia and minimize opioid-related side effects.......Page 631 Other Epidural Opioids......Page 632 Patient-Controlled Epidural Analgesia (PCEA)......Page 633 Dose.......Page 636 Fentanyl......Page 637 Other Intrathecal Opioids......Page 638 Maternal Safety......Page 639 Monitoring and Detection of Respiratory Depression......Page 640 Single antiemetic agents.......Page 641 Pruritus......Page 642 Alpha2-Adrenergic Receptor Agonists......Page 644 Magnesium.......Page 646 Abdominal Fascial Sheath Blocks......Page 647 Key Points......Page 650 References......Page 651 Incidence, Morbidity, and Mortality......Page 665 Esophagus......Page 666 Gastrointestinal Motility......Page 667 Ingestion of Food......Page 668 Risk Factors for Aspiration Pneumonitis......Page 669 Pathophysiology......Page 671 Antibiotics......Page 672 Positive End-Expiratory Pressure......Page 674 Prophylaxis......Page 675 Antacids......Page 676 Metoclopramide......Page 677 Recommendations for Cesarean Delivery......Page 678 Gastric Ultrasonography......Page 679 Oral Intake During Labor......Page 680 References......Page 681 Definitions......Page 686 Incidence and Epidemiology......Page 687 Airway Edema......Page 688 Respiratory and Metabolic Changes......Page 689 Cormack and Lehane Grade......Page 690 Thyromental Distance......Page 691 Other Assessments......Page 692 Recommendations......Page 693 Fasting and Antacid Prophylaxis......Page 694 Patient Positioning......Page 695 Rapid-Sequence Induction and Cricoid Pressure......Page 696 Neuraxial Anesthesia......Page 697 Awake Intubation before General Anesthesia......Page 698 Topical Anesthesia......Page 699 Fiberoptic Intubation......Page 700 Video Laryngoscopy......Page 701 Obstetric Anesthesia Failed Intubation Guidelines......Page 703 Laryngeal Mask Airway......Page 706 Laryngeal Mask Airway as a Conduit for Intubation......Page 708 Cannula and Surgical Cricothyrotomy......Page 709 Airway Exchange Catheters......Page 710 References......Page 711 Differential Diagnosis of Postpartum Headache......Page 718 Migraine......Page 720 Subdural Hematoma......Page 721 Cerebral Venous and Sinus Thrombosis......Page 722 Caffeine Withdrawal......Page 723 Symptoms......Page 724 Imaging......Page 725 Morbid Obesity......Page 726 Direction of bevel of the Quincke needle.......Page 727 Combined spinal-epidural anesthesia.......Page 728 Bed Rest......Page 729 Prophylactic Epidural/Intrathecal Saline......Page 730 Prophylactic Blood Patch......Page 731 Pharmacologic Treatment......Page 732 Epidural Morphine......Page 733 Efficacy.......Page 734 Timing.......Page 735 Infectious/hematologic complications.......Page 736 Dextran/gelatin patch.......Page 737 Summary of Treatment......Page 738 References......Page 739 Obstetric Surveys......Page 746 Peripehral Nerve Palsies......Page 747 Femoral Nerve Palsy......Page 749 Meralgia Paresthetica......Page 750 Postpartum Bladder Dysfunction......Page 751 Trauma to Nerve Roots and the Spinal Cord......Page 752 Trauma Associated with Spinal Anesthesia......Page 753 Incidence.......Page 755 Infection......Page 756 Management.......Page 757 Risk factors.......Page 758 Mask.......Page 760 The Epidural Space......Page 761 Transient Neurologic Syndrome......Page 762 Spinal Tumor......Page 763 Risk Management and Follow-Up......Page 764 References......Page 765 Informed Consent......Page 771 Clinical Capacity versus Legal Capacity......Page 772 Patient Who Is in Pain......Page 774 Patient with a Birth Plan......Page 775 Minor who is pregnant or believes herself to be pregnant.......Page 776 Abortion.......Page 777 Language Considerations......Page 778 Gestational Carriers or Surrogates......Page 779 Conflicts Arising out of the Maternal-Fetal Relationship......Page 780 Intraprofessional Collaborative Practice......Page 782 Medical Liability......Page 783 Disclosure of Unanticipated Outcomes and Medical Errors......Page 784 References......Page 785 Chapter Outline......Page 791 Definitions......Page 792 Neonatal Mortality......Page 793 Neonatal Morbidity......Page 794 Risk Factors......Page 795 Prevention of Preterm Labor......Page 796 Assessment and Therapy......Page 797 Antibiotic Therapy......Page 798 Cerclage removal.......Page 799 Physiology of Uterine Contractions......Page 800 Efficacy of Tocolytic Therapy......Page 801 Method of Delivery......Page 802 Fetal Heart Rate Monitoring......Page 803 Perinatal Effects of Maternal Local Anesthetics......Page 804 Cesarean Delivery......Page 805 Calcium Entry–Blocking Agents......Page 806 Mechanism of Action......Page 807 Anesthetic Management......Page 808 References......Page 809 Abnormal Position......Page 815 Epidemiology......Page 816 Morbidity and Mortality......Page 817 External Cephalic Version......Page 818 Mode of Delivery......Page 819 Vaginal Breech Delivery......Page 820 Cesarean Delivery......Page 821 Anesthesia for vaginal breech delivery.......Page 822 Shoulder Presentation......Page 823 Physiologic Changes......Page 824 Morbidity and mortality.......Page 825 Maternal Complications......Page 826 Twin A......Page 827 Vaginal Delivery of Twin A/Operative Delivery of Twin B......Page 828 Key Points......Page 829 References......Page 830 Classification of Hypertensive Disorders......Page 833 Preeclampsia......Page 834 Epidemiology......Page 835 Genetic factors.......Page 836 Preeclampsia as a Two-Stage Disorder......Page 837 Abnormal Placentation......Page 838 Maternal Systemic Disease......Page 839 Clinical Presentation......Page 841 Cardiovascular......Page 842 Renal......Page 843 Maternal and Fetal Surveillance......Page 844 Treatment of Acute Hypertension......Page 846 Seizure Prophylaxis......Page 847 Cerebrovascular Accident......Page 848 HELLP Syndrome......Page 849 Hemodynamic monitoring.......Page 851 Coagulation status.......Page 852 Intravenous hydration.......Page 853 Neuraxial anesthesia.......Page 854 Airway considerations.......Page 855 Hypertensive response to laryngoscopy.......Page 856 Postoperative analgesia.......Page 857 Long-Term Outcomes......Page 858 Resuscitation and Seizure Control......Page 859 Anesthetic Management......Page 860 References......Page 861 Definition and Pathophysiology......Page 872 Fever Secondary to Infection......Page 873 Chorioamnionitis (Intrauterine Inflammation and/or Infection)......Page 874 Respiratory Tract Infection......Page 875 Postpartum and Surgical Site Infection......Page 876 Screening and Diagnosis......Page 877 Initial Treatment......Page 878 Laboratory Studies......Page 879 Primary and Secondary Infection......Page 880 Interaction with Pregnancy......Page 881 Pathophysiology......Page 882 Cardiovascular Abnormalities......Page 883 Mode of Delivery......Page 884 Neuraxial Anesthesia......Page 885 Key Points......Page 886 References......Page 887 Antepartum Hemorrhage......Page 894 Obstetric Management......Page 895 Anesthetic Management......Page 896 Pathophysiology......Page 897 Uterine Rupture......Page 898 Vasa Previa......Page 899 Epidemiology......Page 900 Prophylaxis.......Page 901 Treatment.......Page 903 Genital Trauma......Page 904 Uterine Inversion......Page 905 Epidemiology......Page 906 Anesthetic Management......Page 907 Invasive Treatment Options......Page 908 Prevention of Mortality......Page 910 Protocols and Team Approach......Page 911 Risks Associated with Transfusion......Page 913 Transfusion Strategies......Page 914 Blood Conservation Techniques......Page 915 Cryoprecipitate.......Page 916 Platelets.......Page 917 Antifibrinolytic therapy.......Page 918 Key Points......Page 920 References......Page 921 Risk Factors......Page 930 Clinical Presentation......Page 931 Diagnosis......Page 932 Anticoagulation......Page 933 Antithrombotic Therapy and Anesthetic Implications......Page 934 Epidemiology......Page 936 Pathophysiology......Page 937 Clinical Presentation......Page 938 Confirmatory Tests......Page 939 Management......Page 940 Maternal and Perinatal Outcomes......Page 941 Clinical Presentation......Page 942 Key Points......Page 943 References......Page 944 Leading Causes......Page 949 Maternal Mortality in the Developed World......Page 952 Risk Factors......Page 954 Anesthesia-Related Maternal Mortality......Page 956 Key Points......Page 959 References......Page 960 Chapter Outline......Page 965 Diagnosis......Page 966 Medical Management......Page 967 Anesthetic Management......Page 968 Pathophysiology......Page 969 Medical and Obstetric Management......Page 970 Effect of Pregnancy......Page 971 Obstetric Management......Page 972 Pathophysiology......Page 973 Anesthetic Management......Page 974 References......Page 975 Chapter Outline......Page 980 Cardiovascular Physiologic Changes of Pregnancy......Page 981 Cardiac Examination during Pregnancy......Page 982 Cardiac Risk Prediction......Page 983 Echocardiography......Page 984 Ionizing Radiation Risks to the Fetus......Page 985 Aortic Diseases and Aortic Dissection......Page 986 Obstetric and Anesthetic Management......Page 987 Patent Ductus Arteriosus......Page 988 Transposition of the Great Arteries......Page 991 Tetralogy of Fallot......Page 992 Eisenmenger Syndrome......Page 994 Anesthetic Management......Page 995 Neuraxial Anesthesia in Patients with Systemic Infection......Page 996 Peripartum Management......Page 997 Supraventricular Arrhythmias......Page 998 Electric Cardioversion......Page 999 Myocardial Infarction......Page 1000 Stent Type Choice......Page 1001 Aortic Stenosis......Page 1002 Obstetric and Anesthetic Management......Page 1003 Aortic Regurgitation......Page 1004 Mitral Stenosis......Page 1005 Tricuspid Stenosis and Regurgitation......Page 1006 Warfarin.......Page 1007 Peripartum Cardiomyopathy......Page 1009 Hypertrophic Cardiomyopathy......Page 1011 Medical Management of Heart Failure......Page 1013 Acute Pericarditis......Page 1014 Cardiopulmonary Resuscitation during Pregnancy......Page 1015 Key Points......Page 1016 References......Page 1017 Predictors of Chronic Pain After Childbirth......Page 1026 Anxiety and Depression......Page 1028 Environmental Factors......Page 1029 Pelvic Pain......Page 1030 Multimodal Approach......Page 1031 Use during pregnancy.......Page 1032 Use immediately postpartum and during lactation.......Page 1033 Use immediately postpartum and during lactation.......Page 1034 Tricyclic antidepressants.......Page 1035 Use during pregnancy and lactation.......Page 1036 Methadone.......Page 1037 Buprenorphine.......Page 1038 Ergot alkaloids.......Page 1039 Anticonvulsants......Page 1040 Management of Intractable Pain After Delivery......Page 1041 Key Points......Page 1042 References......Page 1043 Pathophysiology......Page 1049 Clinical Presentation and Diagnosis......Page 1050 How Does Pregnancy Affect Diabetes Mellitus?......Page 1051 Diabetic ketoacidosis.......Page 1052 How Does Diabetes Mellitus Affect the Mother and Fetus?......Page 1053 Glycemic Control......Page 1055 Anesthetic Management......Page 1056 Thyroid Hormone Physiology......Page 1058 Pathophysiology......Page 1059 Medical and Surgical Management......Page 1060 Thyroid storm.......Page 1061 Preoperative preparation.......Page 1062 Obstetric Management......Page 1063 Clinical Presentation and Diagnosis......Page 1064 Definition and Epidemiology......Page 1065 Clinical Presentation and Diagnosis......Page 1066 Preoperative Preparation......Page 1067 Management during Pregnancy......Page 1068 Anesthetic Management......Page 1069 References......Page 1070 Anemia in Pregnancy......Page 1081 β-Thalassemias......Page 1082 β-thalassemia major.......Page 1083 Epidemiology.......Page 1084 Interaction with pregnancy.......Page 1085 Sickle Cell Disease Variants......Page 1086 Thrombotic and Thrombolytic Pathways......Page 1087 Platelet Function Analyzer......Page 1089 Thrombocytopenic Coagulopathies......Page 1090 Autoimmune Thrombocytopenic Purpura......Page 1091 Thrombotic Thrombocytopenic Purpura......Page 1092 von Willebrand’s Disease......Page 1093 Other Coagulation Factor Deficiencies......Page 1094 Disseminated Intravascular Coagulation......Page 1095 Neuraxial Anesthesia in the Patient With Coagulopathy......Page 1096 Protein S Deficiency......Page 1098 References......Page 1099 Viral Hepatitis......Page 1105 Liver Abscess......Page 1106 Intrahepatic Cholestasis of Pregnancy......Page 1107 Acute Fatty Liver of Pregnancy......Page 1108 Markers of Liver Dysfunction......Page 1109 Acute Liver Failure......Page 1110 Cirrhosis and Chronic Liver Failure......Page 1111 Anesthetic Considerations......Page 1112 Pharmacokinetic Effects of Liver Failure......Page 1113 Key Points......Page 1114 References......Page 1115 Genetics......Page 1119 Clinical Presentation......Page 1120 Testing......Page 1121 Effects on the Fetus and Newborn......Page 1122 Analgesia for Labor......Page 1123 Obstetric Drugs in Malignant Hyperthermia–Susceptible Parturients......Page 1124 Assessment of Hyperthermia and Tachycardia......Page 1125 Treatment......Page 1126 Dantrolene in Pregnancy......Page 1127 References......Page 1128 Lumbopelvic Pain of Pregnancy......Page 1132 Chronic Low Back Pain......Page 1133 Scoliosis......Page 1134 Interaction with Pregnancy......Page 1136 Obstetric Management......Page 1137 Anesthetic Management......Page 1138 Rheumatoid Arthritis......Page 1140 Medical Management......Page 1141 Ankylosing Spondylitis......Page 1142 Anesthetic Management......Page 1143 Spinal Dysraphism......Page 1144 Anesthetic Management......Page 1145 Osteogenesis Imperfecta......Page 1147 Anesthetic Management......Page 1148 References......Page 1149 Chapter Outline......Page 1153 Multiple Sclerosis......Page 1154 Anesthetic Management......Page 1155 Tension Headache......Page 1156 Obstetric and Anesthetic Management......Page 1157 Spinal Cord Injury......Page 1158 Obstetric Management......Page 1159 Anesthetic Management......Page 1160 Myasthenia Gravis......Page 1161 Anesthetic Management......Page 1162 Interaction with Pregnancy......Page 1163 Myotonia and Myotonic Dystrophy......Page 1165 Anesthetic Management......Page 1166 Neurofibromatosis......Page 1167 Obstetric and Anesthetic Management......Page 1168 Anesthetic Management......Page 1169 Obstetric Management......Page 1170 Anesthetic Management......Page 1171 Intracerebral Hemorrhage......Page 1173 Anesthetic Management......Page 1174 Amyotrophic Lateral Sclerosis......Page 1175 Meralgia Paresthetica......Page 1176 References......Page 1177 Cardiopulmonary Changes......Page 1183 Gastrointestinal Changes......Page 1184 Other Comorbidities......Page 1185 Progress of Labor and Method of Delivery......Page 1186 Labor and Vaginal Delivery......Page 1187 Cesarean Delivery......Page 1189 Neuraxial Techniques......Page 1190 Local anesthetic dosing for neuraxial techniques.......Page 1191 Induction and maintenance of anesthesia.......Page 1192 Postoperative Analgesia......Page 1193 Thromboprophylaxis......Page 1194 References......Page 1195 Epidemiology......Page 1200 Anxiety Disorders......Page 1201 Personality Disorders......Page 1202 Psychotropic Drugs......Page 1203 Key Points......Page 1205 References......Page 1206 Definition and Pathophysiology......Page 1208 Effect of Pregnancy on Preexisting Kidney Disease......Page 1209 Effect on the Mother and Fetus......Page 1210 Hemodialysis and Long-Term Ambulatory Peritoneal Dialysis......Page 1211 Neuraxial Anesthesia......Page 1212 Definition and Epidemiology......Page 1213 Intrarenal Causes......Page 1214 Effect on the Mother and Fetus......Page 1215 Effect of Pregnancy on the Renal Allograft......Page 1216 Medical and Obstetric Management......Page 1217 Diagnosis......Page 1218 Key Points......Page 1219 References......Page 1220 Airway Smooth Muscle......Page 1224 Airway Inflammation......Page 1225 Effects of Asthma on the Parturient and Fetus......Page 1226 Bronchodilators......Page 1227 Antiinflammatory Agents......Page 1228 Management during Labor and Vaginal Delivery......Page 1229 Management during Cesarean Delivery......Page 1230 Medical Management......Page 1231 Effect of Cystic Fibrosis on Pregnancy......Page 1232 Pathophysiology......Page 1233 Medical Management......Page 1234 References......Page 1235 Epidemiology......Page 1241 Anesthetic Management......Page 1243 Anesthetic Management......Page 1247 Anesthetic Management......Page 1248 Systemic Effects......Page 1249 Cocaine......Page 1250 Systemic Effects......Page 1251 Effects on Pregnancy and the Fetus......Page 1252 Systemic Effects......Page 1253 Pharmacology......Page 1254 Pharmacology......Page 1255 Effects on Pregnancy and the Fetus......Page 1257 Labor analgesia.......Page 1258 Systemic Effects......Page 1259 Key Points......Page 1260 References......Page 1261 Complications and Outcomes......Page 1267 Fetal Trauma and Outcome......Page 1268 Initial Assessment and Resuscitation......Page 1269 Airway......Page 1270 Circulation......Page 1271 Fluid resuscitation.......Page 1272 Secondary Survey......Page 1273 Laboratory Studies......Page 1274 Traumatic Brain Injury......Page 1275 Cardiopulmonary Resuscitation......Page 1276 Ischemic Stroke......Page 1277 Intracerebral hemorrhage.......Page 1278 Subarachnoid hemorrhage.......Page 1279 Acute Respiratory Distress Syndrome......Page 1280 Ventilatory Strategies......Page 1281 Nonventilatory Strategies......Page 1282 Sepsis......Page 1283 Pathophysiology......Page 1284 Vasopressors and inotropes.......Page 1285 Monitoring resuscitation.......Page 1286 The Fetus during Critical Maternal Illness......Page 1287 References......Page 1288 Committee of Origin: Obstetric Anesthesia......Page 1293 Appendix B Practice Guidelines for Obstetric Anesthesia: an Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology......Page 1295 Category A.......Page 1296 Survey findings.......Page 1297 Literature findings.......Page 1298 Literature findings.......Page 1299 Survey findings.......Page 1300 CSE analgesia......Page 1301 Literature findings.......Page 1302 General, Epidural, Spinal, or CSE Anesthesia......Page 1303 Literature findings.......Page 1304 Cardiopulmonary Resuscitation.......Page 1305 Antacids, H2-Receptor Antagonists, and Metoclopramide......Page 1306 Nitroglycerin for Uterine Relaxation......Page 1307 Equipment for Management of Airway Emergencies......Page 1308 Anesthetic Care for Labor and Vaginal Delivery......Page 1309 State of the Literature......Page 1310 Correspondence......Page 1311 References......Page 1312 Committee of Origin: Obstetric Anesthesia......Page 1319 References......Page 1320 The Obstetric Anaesthetists Association (OAA)......Page 1321 The Canadian Anesthesiologists’ Society (CAS)......Page 1322 The Obstetric Anesthesia Digest......Page 1323 Anesthesia Illustrated–SOAP......Page 1324 Symplur Healthcare Hashtags......Page 1325