1. PRF. TARIK Y. ZAMZAMI MD, CABOG, fICS PROFESSOR & OB/GYN CONSULTANT KAUH SCHOOL OF MEDICINE Email.tzamzami@kaau.edu.sa

2. Analgesia & Anesthesia in Obstetrics Pain relief in labor: is it important !

3. Advantages: n Child birth n Pain-Fear-Anxiety Syndrome

4. Surgical VS Obstetrics Patients n Patient n Uterine contractions n Duration n Preparation

5. What Are The Criteria? n Fetal homeostasis n Simplicity n Safety

6. I- Obstetric Analgesia n Narcotic injection n Inhalation

7. II- Obstetric Analgesia&Anesthesia n Regional Anesthesia:. Epidural. Spinal. Local n General Anesthesia

8. Narcotic Analgesia n Pethidine n Dose 50 - 100 mg n Route I/M n Frequency 3 - 4 hours n Promethazine 25 mg I/M

9. Side Effect n Mother:.Euphoria.Nausea&Vomiting.Dizziness n Fetus:.Respiratory depression

10. Narcotic Antagonist n Naloxon hydrochloride (Narcan) n Action n Dose 10 µg/kg

11. Inhalation Analgesia n Anesthetic agent:.Entonoxe.Nitrous oxide.50:50 %

12. Epidural n Excellent n Portal entry: L 3 - L 4 n Labor&vaginal delivery: Block T 10 - S 5 n Cesarean section: Block T 8 - S 1 n A.Agent: Marcain n Duration: 1 - 3 hours

13. Indications n Maternal request n Malpresentation n Multiple pregnancy n Preterm labor n Cardiac disease

14. Contraindications n Patient refused n Local sepsis n Anti-coagulant therapy n Obstructive cardiomyopathy n Bleeding n Inadequate staff n Previous surgery

15. Complications n Hypotension n Bladder dysfunction n Dural tap n Incomplete analgesia

16. Spinal Analgesia n Port entry: L 3 - L 4 n Space: subarachnoid n Level of blockade: T 10 - T 6

17. Indications n Manual removal of placenta n Cesarean section

18. Complications n Total spinal blockade n Spinal headache n Hypotension n Bladder dysfunction

19. Local Anesthesia n Pudendal block n Local infiltration

20. Pudendal Block n Technique n Indication n Disadvantages

21. Local Infiltration n Technique n Indication

22. General Anesthesia Is one of the leading cause of maternal death in obstetrics

23. Complications n Respiratory depression of new born n Postpartum hemorrhage n Gastric aspiration

24. Mendelson Syndrome

25. Effect of Pregnancy on Stomach n Delay gastric emptying n Relaxation of gastro-esophageal sphincter n Raised intragastric press

26. Clinical Features of Aspiration Pneumonia n Tachypnea n Bronchospasm n Hypotension n Cyanosis n Atelectasis

27. Prevention of Mendelson Syndrome n Well trained Anesthetist n NPO for 12 hours n Eating&drinking are prohibited during labor n Antacid