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1、AnesthesiaforCesareanSectionMichelleGros,FRCPCFeb13,2008CesareanSectionCesareansectionrateinCanadain2005was23.7%(CIH)CesareansectionrateinUSnowexceeds24%Incidenceofanesthesia-relatedmaternalmortalityisdecliningAnesthesiaremainsresponsiblefor~3-12%ofallmaternaldeathsMajorit
2、yduringgeneralanesthesia(failedintubation,failedventilationandoxygenation,andoraspiration)Associatedfactorsincludeobesity,hypertensivedisordersofpregnancy,andemergentlyperformedproceduresCesareanSectionReviewofanesthetictechniqueusedforallc-sectionsperformedatBrighamandWom
3、en’shospitalbetween1990and1995GA?from7.2%in1990to3.6%in1995ArewegettingenoughexperienceinGA’sforc-sections?PreparationforAnesthesia-MedsMinimizedrugspriortodeliveryofinfantIfnecessary,midazolam0.5–1mgorfentanyl25-50ugIVSmalldoses–minimalfetalandneonataldepressionDisadvanta
4、geofbenzos–?Anticholinergics–decreasessecretionsAtropine–crossesplacenta-?FHRand?variabilityGlycopyrrolate–doesnotcrossplacentaAspirationprophylaxisPreparationforAnesthesia-MedsCJA2006;53(1):79-85.RCTof60womenEither1ug/kgfentand0.02mg/kgmidazIV,ORanequalvolumeIVNSattimeofs
5、kinprepforspinalNobetweengroupdifferencesofneonataloutcomevariables(Apgar,neurobehaviouralscores,continuousoxygensaturation)MothershadnodifferenceinrecallofthebirthPreparationforAnesthesia–IVFluidsPriortoregional–15-20mL/kgRLorNS30minspriorRoutetal.1993–incidenceofhypotens
6、ion?from71%to55%ifprehydratedMessage:AdditionalmeansarenecessaryInurgentsituation–notnecessarytowaitforfluidbolus?hypotension–meansimproveduteroplacentalperfusion?crystalloidvs.colloidPreparationforAnesthesia–IVFluidsCJA2000;47:607-610.Crystalloidpreloadnolongermagicbullet
7、Studyfound1LcrystalloidpreloadwasofnovalueinpreventinghypotensionBothspeedandvolumeofpreloadingunimportantStillreasonabletogivemodestpreloadpriortospinalPatientsareoftenrelativelydehydratedBUT–noneedtodelayemergencysurgeryinordertopreloadPreparationforAnesthesia–IVFluidsSi
8、ddikshowed500mLpentaspanmoreeffectivethan1LNSinreducinghypotension(40%vs.80%)N+Valsoreduc
