Labor Stage 1: Obstetric Anesthesia

00:01 Now let's discuss Obstetric Anesthesia.

00:05 So we have a lot of options for managing pain in labor.

00:09 Let's take time to talk about each of these.

00:11 First is inhaled anesthesia.

00:15 So this is in the form of nitrous oxide also known as Laughing Gas.

00:19 It's inhaled intermittently in labor.

00:21 Mom is in control of that.

00:24 Pain relief however is minimal and is short lasting.

00:28 The side effects are nausea, dizziness and light headedness.

00:32 Nitrous oxide can be used for labor but not for cesarean sections.

00:39 Now let's talk about systemic opoid anesthesia.

00:44 So basically narcotics are given intravenously.

00:46 We have to be careful though because if they are given intravenously, that means that they go to the placenta and they can effect the fetus.

00:54 Pain relief is minimal and short lasting.

00:57 And they should not be given within 4 hours prior to expected to delivery.

01:02 Again because it is intravenous it goes to the placenta and the fetus can give the affects of the narcotic.

01:10 Maternal side effects are nausea, vomiting and drowsiness.

01:15 Fetal or neonatal side effects are fetal heart rate abnormalities or respiratory depression.

01:22 Now let's talk about local opoid anesthesia.

01:28 So this would be in the form of pudental nerve block as demonstrated here.

01:34 It could be used for operative vaginal delivery or repair of laceration or episiotomy.

01:39 So it's not typically used during the labor process.

01:42 And it cannot be used for cesarean sections as it would not provide anesthesia to the area needed.

01:47 But it can be used when you're using operative vaginal delivery.

01:51 It provides great pain relief along the nerve distribution.

01:55 Now you have to be cautious when you're doing a pudental nerve block because you can have potential hemorrhage if the pudental artery is accessed instead of the nerve.

02:04 Now, let's talk about regional opoid anesthesia.

02:10 So this is in the form of epidural or spinal.

02:13 So epidural anesthesia typically used for labor but it can be used for C-section.

02:19 During epidural placement a catheter is placed in the epidural space to inject medication.

02:25 It gives great pain relief from T8 to below but it can be spotty.

02:31 That means that patients can have what they call Hot Spots where they don't feel the pain relief in that area.

02:38 Now the maternal side effect of an epidural is hypotension.

02:41 This is particularly important specially for labor in patients.

02:45 With that hypotension patients can experience utero-placental insufficiency and that can affect the fetus.

02:52 And the fetus will manifest having that hypotension by having late decelerations.

02:59 So spinal anesthesia.

03:00 This is injected into the spinal fluid and it's used for C-sections.

03:05 It gives great relief from T10 to below.

03:07 So a little bit lower than an epidural and it last from between 2 to 4 hours.

03:13 Again the maternal side effect is hypotension and bradycardia.

03:17 And with that again, the fetus can start to have late decelerations as a manifestation of utero-placental insufficiency.

03:27 Now let's talk about general anesthesia.

03:31 So general anesthesia is reserved only for emergency C-sections.

03:35 Typically with C-section again we use an epidural or we use spinal anesthesia.

03:40 And even in some emerging cases we can still use epidural or spinal.

03:45 However, if it is an extreme emergency situation we would need to do a C-section.

03:51 General anesthesia is usually reserved for emergency sections or non-emergency sections where there is a contraindication to epidural or spinal anesthesia.

04:00 Contraindications for spinal anesthesia include intracranial masses or a history of extensive back surgery.

04:08 A lot of times moms can have vomiting and that can result in aspiration pneumonitis.

04:12 Specially if mom has any food in her stomach or has not been in PO for 8 hours.

04:19 Fetal side effects of general anesthesia, respiratory depression.