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Cambridge.University.Press.Analgesia.Anaesthesia.and.Pregnancy.A.Practical.Guide.Jun.2007. This page intentionally left blankAnalgesia, Anaesthesia and PregnancyA practical guideA thoroughly updated edition of this well-established practical guide toobstetric analgesia and anaesthesia. All aspects of obstetric medicine relevantto the anaesthetist are covered, from conception, throughout pregnancy,to after-birth care.The emphasis is on pre-empting problems and maximising quality of care.The authors have identified over 150 potential complications each covered intwo sections: issues raised and management options, with key points extractedinto boxes for quick reference. A section on organisational aspects such asrecord keeping, training, protocols and guidelines makes this an importantresource for any labour ward or hospital dealing with pregnant women.Presented in a clear, structured format, this book will be invaluable to traineeanaesthetists at all levels and to experienced anaesthetists who encounterobstetric patients. Obstetricians, neonatologists, midwives, nurses and operat-ing department practitioners wishing to extend or update their knowledge willalso find it highly beneficial.Steve Yentis is a Consultant Anesthetist at Chelsea and Westminster Hospital,London and Honorary Senior Lecturer at Imperial College, London.Anne May is a Consultant Obstetric Anaesthetist at Leicester Royal InfirmaryNHS Trust and Honorary Senior Lecturer at the University of Leicester.Surbhi Malhotra is a Consultant Anaesthetist at St Mary’s Hospital, London.From reviews of the First Edition:‘This is a book that openly professes to be a ‘‘short practical text’’ – and it hasachieved its objective very successfully indeed. Clearly set out with discretewell-organized chapters, the text is easy to read and presents a comprehensiveoverview of a difficult field in a ‘‘user-friendly’’ form.’European Journal of Anaesthesiology‘The diversity of topics and their limited analysis makes it easy to read the textquickly and pick up key points. At the end of each topic is a bullet pointsynopsis. . . It is these characteristics of the book that create the practicalapproach. . . The book . . . is certain to be popular given its broad authorshipand succinct style.’British Journal of Anaesthesia‘The authors have succeeded in producing an excellent book in a style thatsets it apart from, and possibly above, recent similar publications . . . . The bookachieves its aim of targeting anaesthetists in training at all levels, and wouldprovide a useful handbook for both the experienced and the occasionalconsultant obstetric anaesthetist.’International Journal of Obstetric AnesthesiaAnalgesia, Anaesthesiaand PregnancyA Practical GuideSecond EditionEdited bySTEVE YENTIS,ANNE MAY andSURBHI MALHOTRAWith David Bogod, Diana Brighouse and Chris EltonCAMBRIDGE UNIVERSITY PRESSCambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São PauloCambridge University PressThe Edinburgh Building, Cambridge CB2 8RU, UKFirst published in print formatISBN-13 978-0-521-69474-2ISBN-13 978-0-511-28897-5© Cambridge University Press 2007Every effort has been made in preparing this publication to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing throughresearch and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this publication. Readers are strongly advised to pay careful attention to information providedby the manufacturer of any drugs or equipment that they plan to use.2007Information on this title: publication is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press.ISBN-10 0-511-28897-2ISBN-10 0-521-69474-4Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.Published in the United States of America by Cambridge University Press, New Yorkwww.cambridge.orgpaperbackeBook (EBL)eBook (EBL)paperbackContentsList of contributors page xiiiPreface xvSECTION 1 – PRECONCEPTION AND CONCEPTION1 Assisted conception 12 Ovarian hyperstimulation syndrome 33 Anaesthesia before conception or confirmation of pregnancy 5SECTION 2 – PREGNANCYI Procedures in early/mid-pregnancy 74 Cervical suture (cerclage) 75 Ectopic pregnancy 86 Evacuation of retained products of conception 107 Incidental surgery in the pregnant patient 128 Intrauterine surgery 149 Termination of pregnancy 16II Normal pregnancy and delivery 1810 Anatomy of the spine and peripheral nerves 1811 Physiology of pregnancy 2712 Aortocaval compression 3113 Normal labour 3314 Gastric function and feeding in labour 3515 Drugs and pregnancy 3716 Placental transfer of drugs 3917 Prescription and administration of drugs by midwives 4218 Local anaesthetics 4419 Antenatal fetal monitoring 4620 Charting of labour 4821 Intrapartum fetal monitoring 5122 Pain of labour 5423 Epidural analgesia for labour 5624 Epidural test doses 6025 Combined spinal-epidural analgesia and anaesthesia 6326 Spinal analgesia 6727 Caudal analgesia 6928 Spinal and epidural opioids 6929 Inhalational analgesic drugs 7230 Systemic analgesic drugs 7431 Non-pharmacological analgesia 77III Operative delivery and third stage 8032 Instrumental delivery 8033 Caesarean section 8234 Epidural anaesthesia for Caesarean section 8635 Spinal anaesthesia for Caesarean section 9036 General anaesthesia for Caesarean section 9437 Cricoid pressure 9838 Failed and difficult intubation 9939 Awake intubation 10340 Post-Caesarean section analgesia 10441 Removal of retained placenta 107IV Anaesthetic complications 11042 Bloody tap 11043 Dural puncture 111vi Contents44 Postdural puncture headache 11445 Epidural blood patch 11646 Extensive regional blocks 11847 Inadequate regional analgesia in labour 12248 Backache 12449 Horner’s syndrome and cranial nerve palsy 12650 Peripheral nerve lesions following regional anaesthesia 12851 Spinal cord lesions following regional anaesthesia 13052 Arachnoiditis 13253 Cauda equina syndrome 13454 Opioid-induced pruritus 13555 Shivering 13656 Aspiration of gastric contents 13857 Awareness 14158 Air embolism 144V Problems confined to obstetrics 14759 Induction and augmentation of labour 14760 Oxytocic and tocolytic drugs 14961 Premature labour, delivery and rupture of membranes 15262 Malpresentations and malpositions 15463 External cephalic version 15664 Multiple pregnancy 15765 Trial of scar 15966 Under-age pregnancy and advanced maternal age 16167 Placenta praevia 16268 Placental abruption 16569 Prolapsed cord 16670 Fetal distress 16871 Intrauterine death 17072 Uterine inversion 172Contents vii73 Major obstetric haemorrhage 17374 Postpartum haemorrhage 17675 Collapse on labour ward 17976 Maternal cardiopulmonary resuscitation 18077 Amniotic fluid embolism 18278 Cholestasis of pregnancy (obstetric cholestasis) 18379 Acute fatty liver of pregnancy 18580 HELLP syndrome 18781 Hypertension, pre-eclampsia and eclampsia 18982 Magnesium sulphate 19683 Hyperemesis gravidarum 19884 Maternal mortality 201VI Problems not confined to obstetrics 20485 Allergic reactions 20486 Cardiovascular disease 20687 Arrhythmias 21088 Pulmonary oedema 21289 Cardiomyopathy 21390 Coarctation of the aorta 21691 Prosthetic heart valves 21892 Congenital heart disease 22093 Pulmonary hypertension and Eisenmenger’s syndrome 22394 Ischaemic heart disease 22695 Endocrine disease 22896 Diabetes mellitus 22997 Anaemia and polycythaemia 23298 Deep-vein thrombosis and pulmonary embolism 23499 Thrombophilia 237100 Coagulopathy 240viii Contents . analgesia and anaesthesia 6326 Spinal analgesia 6727 Caudal analgesia 6928 Spinal and epidural opioids 6929 Inhalational analgesic drugs 7230 Systemic analgesic. This page intentionally left blank Analgesia, Anaesthesia and PregnancyA practical guideA thoroughly updated edition of this well-established practical guide
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