Chapter 58
- Anesthesia for Obstetrics
- David J. Birnbach
- Ingrid M. Browne
Introduction
The challenges presented by a parturient requiring anesthesia
or analgesia, or both, make the role of the obstetric anesthesiologist both challenging
and rewarding. Those providing anesthetic services to the labor and delivery suite
must be familiar with the unique physiology of the parturient and the effects of
numerous drugs and techniques on the parturient and fetus.
Continuous improvements in drugs and techniques have led to a
significant decrease in anesthetic-related deaths in the delivery suite. The maternal
mortality rate in the United States is estimated at 7.5 per 100,000 live births[1]
;
however, many suggest that this statistic is misleading because of underreporting
of maternal deaths.[2]
A recent retrospective analysis
of maternal mortality during hospital admission by Panchal and colleagues suggested
that anesthesia-related complications accounted for 5.2% of maternal deaths.[3]
In 1992, the American College of Obstetricians and Gynecologists
(ACOG) and the American Academy of Pediatrics made recommendations concerning anesthetic
coverage in the labor and delivery suite. These recommendations included the availability
of 24-hour coverage in larger facilities for complicated patients, the ability to
perform an emergency cesarean section in all facilities with delivery suites, and
the availability of properly trained personnel to manage anesthetic complications.
[4]
Appreciation of the roles of the obstetrician, anesthesiologist,
pediatrician, and other personnel who care for the mother and child will facilitate
the highest level of care. Communication between the various members of the labor
and delivery team is paramount. This chapter will provide an overview of the principles
and techniques that can be used by the anesthesiologist in the labor and delivery
suite.
