Michael Paech; Handbook of Obstetric Anesthesia. Handbook of Obstetric Anesthesia. By Mark C. Pages: In a world of complex, multiauthored textbooks about obstetric anesthesia, where readers require the physique of a body builder to pick up the tome and a sturdy and voluminous bookshelf for its storage, Mark Norris has produced a rather different text. This is a handbook, light in weight and designed for easy carriage in the hand or the pocket.
It doubles as both a ready reference and a textbook, suitable for those needing immediate information but also for those with recourse to a comfortable armchair for later reflection. Norris focuses on topics of practical relevance and modifies management recommendations based on his personal opinion and practice.
The handbook broadly covers preoperative assessment physiology and considerations for various diseases , intraoperative management practical anesthesia and analgesia applied to surgery in pregnancy, labor, and cesarean delivery , and topics after delivery. Thirty three chapters provide a comprehensive overview of care of the parturient.
I assumed that this handbook would provide mainly basic information in an easily digestible format. The latter preconception was met, because the book contains a useful index, has clear headings with text in sequential point format, and is complimented by many tables and the occasional drawing or graphic. What proved unexpected and astonishing was the amount of information and its quality, a testament to the knowledge and experience of the author.
The practical recommendations or instructions for techniques are by nature often didactic or reflect a personal approach, but are nevertheless sensible and consistent with consensus views. What is there to criticize? Not a great deal. If you are looking for a balanced discussion of the merits of combined spinal—epidural versus epidural analgesia in labor, the current role of epidural clonidine, or the etiology of preeclampsia, there are better alternatives.
The point style lends itself well to most topics e. I found it frustrating trying to read the staccato style for any lengthy period and the referencing is esoteric, spasmodic, and limited.
In summary, this book fulfills a niche role for the subspecialty and is good value for its price. It offers a little for everyone. Early trainees looking for facts and the occasional obstetric anesthesiologist wanting to check the current approach to general anesthesia or the implications of dealing with maternal diabetes will find it useful, as may the specialist wanting a comprehensive summary in a ready reference format.
Sign In or Create an Account. Advanced Search. Sign In. Skip Nav Destination Article Navigation. This is mainly due to an increase in tidal volume. P a CO 2 - falls and stabilizes at 4. P a O 2 - rises to 14 kPa mmHg during the third trimester in the erect position ; this is due to the fall in P a CO 2 plus a reduced arteriovenous oxygen difference. The P a O 2 declines slightly by term - the rise in cardiac output does not keep pace with to the increased oxygen consumption and arteriovenous oxygen difference increases.
Ventilation during labour : Pain and anxiety during labour may induce significant further changes to some of the above values. Table 1. Materno-fetal respiratory gas exchange. Although fetal partial pressure of oxygen is much lower, the saturation is relatively higher than in the adult.
The fetal oxy-haemoglobin dissociation curve is displaced to the left see fig 1. Important shifts of the dissociation curves take place in the placenta. The maternal blood gains CO 2 , the pH falls and the curve shifts to the right releasing additional oxygen. On the fetal side of the placenta CO 2 is lost, the pH rises and the curve shifts to the left allowing additional oxygen uptake double Bohr effect. Other important factors in delivery of oxygen to the fetal tissues are:.
As pregnancy progresses the intra abdominal pressure increases and the axis of the stomach is altered. There is no evidence of delayed gastric emptying during pregnancy. By contrast prolonged labour is associated with impaired gastric emptying and increased gastric volume. The administration of opioids aggravates these changes, and also reduce the tone of the LOS. These physiological changes can be expected to return to normal within 24 - 48 hours of delivery.
The upper oesophageal sphincter UOS is formed mainly from the striated cricopharyngeus muscle. Its pressure varies from 40 mmHg when awake to 8 mmHg during deep sleep. Regurgitation will occur when this pressure falls below that of the oesophageal contents. The UOS may retain sufficient tone to prevent regurgitation of oesophageal contents during general anaesthesia with volatile agents in the absence of neuromuscular blockade: however this cannot be relied upon.
Glomerular filtration rate and renal plasma flow increase rapidly in the first trimester. There is an increase in urine production and frequency of micturition. The clearances of urea, creatinine and urate are correspondingly increased and serum levels are below non pregnant levels table 1. Aldosterone, progesterone and renin-angiotensin activity increase and there is a rise in total body water and sodium.
Progesterone causes ureteric dilatation; the associated urinary stasis may precipitate infection. Slight elevations in aspartate aminotransferase AST , lactate dehydrogenase LDH and alkaline phosphatase occur during pregnancy. This appears to be due to haemodilution rather than decreased synthesis. In practice the duration of action of suxamethonium is increased by minutes in the first week postpartum; this is not a clinical problem.
Bonica JJ. Principles and Practice of O bstetric Analgesia. Conclin KA. Physiologic changes of pregnancy. In:Chestnut DH ed. Obstetric Anesthesia. St Louis: Mosby,; Chamberlain G and Pipkin B. Clinical Physiology in Obstetrics ; Blackwell Science, Nocturnal hypoxaemia in late pregnancy.
British Journal of Anaesthesia ; Click here for Medline link. Optimisation of fetal oxygenation. International Journal of Obstetric Anesthesia ; 4 Increase in Mallampati score during pregnancy. British Journal of Anaesthesia ; 74 : Vanner RG. Mechanisms of regurgitation and its prevention with cricoid pressure. International Journal of Obstetric Anesthesia ; The symptoms of PTSD usually begin within 3 months of the traumatic event.
However, sometimes they surface many years later. The duration of PTSD, and the strength of the symptoms, vary. For some people, recovery may be achieved in 6 months; for others, it may take much longer. There are three categories of symptoms. The first involves re-experiencing the event. This is the main characteristic of PTSD and it can happen in different ways. Most commonly the person has powerful, recurrent memories of the event, or recur-rent nightmares or flashbacks in which they re-live their distressing experience.
The anniversary of the triggering event, or situations which remind them of it, can also cause extreme discomfort. Avoidance and emotional numbing are the second category of symptoms. The first occurs when people with PTSD avoid encountering scenarios which may remind them of the trauma. Emotional numbing generally begins very soon after the event.
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