Obstetric anesthesia

Abstract

Obstetric anesthesia has developed over the last 150 years, and has grown into a dominant specialty of its own. This parallels an important change in the philosophical thinking and attitude to the relief of pain in labor. The safety of obstetric anesthesia has increased, primarily as a result of the awareness of local anesthetic toxicity and the increased use of regional anesthesia. Maternal mortality directly related to anesthesia has dramatically decreased. This chapter outlines the safe conduct of analgesic and anesthetic techniques for parturients. Current opinion on the role of newer techniques, such as combined spinal-epidural analgesia and walking epidurals, is discussed. No techniques are immune to controversy. Thus, a section on current controversies in obstetric anesthesia has been included. The current thinking on the effect of regional anesthesia on both the progress and outcome of labor is detailed. As anesthesiologists working in general surgery may still encounter pregnant patients, we describe the principles of anesthesia for nonobstetric surgery during pregnancy. The anesthetic implications of pre-eclampsia are reviewed, and specific considerations for other highrisk obstetric patients are highlighted. Modern practice has resulted in a consistently diminishing incidence of maternal deaths that can be directly attributed to anesthesia.