Spinal Anaesthesia PDF
Preview Spinal Anaesthesia
Normal physiologic adaptation to pregnancy. Impact on anesthetic practice. Anesthesia and analgesia for normal vaginal delivery and Cesarean section. Marc Van de Velde, MD, PhD, EDRA Professor of Anaesthesia, Department Cardiovascular sciences KUL Chair Department of Anaesthesiology, University Hospitals Leuven (UZL) Leuven, Belgium [email protected] Physiologic adaptations to pregnancy and anesthetic impact Anesthesia for C-section Labour analgesia Physiologic adaptations to pregnancy and anesthetic impact Anesthesia for C-section Labour analgesia Weight gain throughout pregnancy. Respiratory physiology. • Oxygen consumption: + 60%. • Increased thoracic cage circumference. • Elevated position of the diaphragm. • Capillary engorgement nasopharynx and larynx. • Airway dilation due to progesterone and relaxin. Blood Gas Values. Respiratory physiology during labor. • Minute ventilation: +100 – 300 % • PaCO : 10 – 20 mmHg 2 • Oxygen consumption: + 75% • Epidural analgesia blunts these changes • Accentuation of the first heart sound • Mild tricuspid regurgitation • ECG-changes: – P-R interval shorter – Q-T interval shorter Central Hemodynamics. – Depressed S-T segments in the left-sided pre-cordial leads • Left ventricular hypertrophy • Mild pericardial effusion Aortocaval compression. Cardiac output during labor and delivery. (cid:1) Elevation sympathetic nervous system activity. (cid:1) Autotransfusion during contractions from intervillous space. (cid:1) Epidural analgesia blunts these changes.
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