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Obstetric anaesthesia
Obstetric Anaesthesia
B. J. Pollard, D. D. Moir
A feature of obstetric care in the first stage of labour which has undergone considerable evolution over the years is the provision of analgesia. Epidural techniques are regarded by most as the present state of the art. They are not, however, without their problems and limitations and there is not universal agreement on the best technique. Which local analgesic agent should we use? In what concentration? Should opioids be used? These and other controversial points are raised in the fourth article in the mini-symposium. Detailed records of maternal mortality have been kept for over 50 years and records in less detail for far longer. They have been published as three-yearly reports since 1952. It is only by such techniques of audit that we can hope to improve the service and the evidence shows that dramatic improvements have indeed taken place. We still do not have a perfect service, however, and anaesthesia still contributes to maternal mortality. This problem, together with the recommendations for further improvements, are reviewed in the fifth article. The final paper in this mini-symposium covers eclampsia and pre-eclampsia. Pre-eclampsia is a not uncommon problem and may be associated with significant maternal and fetal morbidity and mortality. Although a condition which is still not fully understood it is an important subject which has a bearing on the anaesthetist. Techniques for controlling blood pressure and the choice of anaesthetic techniques are still subject to much debate. In addition to the mini-symposium the opportunity has been taken to include a pharmacology article of direct relevance to this subject. The subject of the placental transfer of drugs nicely complements the mini-symposium.
Obstetric anaesthesia is one of the most important of the sub-specialties of anaesthesia and one in which all trainees require a reasonable amount of experience. It is right therefore that we devote a whole mini-symposium to this important subject. The mini-symposium begins with the discussion of the physiological changes associated with pregnancy. Practically every system of the body is affected by these changes, which are designed for the wellbeing of the fetus. These differences do mean that the pregnant mother may respond differently to the non-pregnant patient in a number of important ways, which may affect both general and regional anaesthetic techniques. It is vital, therefore, that the anaesthetist fully appreciates these changes in order to ensure the safety of the mother and fetus. Modern general anaesthesia is inherently very safe. When disaster strikes, however, it can have devastating consequences, particularly when the patient concerned is a young mother. In the quest for even greater safety more emphasis has been placed upon regional anaesthesia over the years and in many hospitals more Caesarean Sections are performed under regional blockade than under general anaesthesia. Neither technique is without its problems. There is, furthermore, considerable ongoing debate about the place of spinals and also combined spinals with epidurals. Two articles are therefore included in the mini-symposium which discuss the places of general and regional anaesthetic techniques for Caesarean Section.
Dr D. D. Moir, St David’s Perthshire PH7 3PJ, UK
Cottage,
Madderty
St Davids,
Crieff,
Currenr Anoesthesia and Crmcal Care (1991 I 2. 67 0
1991 Longman
Group
UK Ltd
67
B. J. Pollard, D. D. Moir
A feature of obstetric care in the first stage of labour which has undergone considerable evolution over the years is the provision of analgesia. Epidural techniques are regarded by most as the present state of the art. They are not, however, without their problems and limitations and there is not universal agreement on the best technique. Which local analgesic agent should we use? In what concentration? Should opioids be used? These and other controversial points are raised in the fourth article in the mini-symposium. Detailed records of maternal mortality have been kept for over 50 years and records in less detail for far longer. They have been published as three-yearly reports since 1952. It is only by such techniques of audit that we can hope to improve the service and the evidence shows that dramatic improvements have indeed taken place. We still do not have a perfect service, however, and anaesthesia still contributes to maternal mortality. This problem, together with the recommendations for further improvements, are reviewed in the fifth article. The final paper in this mini-symposium covers eclampsia and pre-eclampsia. Pre-eclampsia is a not uncommon problem and may be associated with significant maternal and fetal morbidity and mortality. Although a condition which is still not fully understood it is an important subject which has a bearing on the anaesthetist. Techniques for controlling blood pressure and the choice of anaesthetic techniques are still subject to much debate. In addition to the mini-symposium the opportunity has been taken to include a pharmacology article of direct relevance to this subject. The subject of the placental transfer of drugs nicely complements the mini-symposium.
Obstetric anaesthesia is one of the most important of the sub-specialties of anaesthesia and one in which all trainees require a reasonable amount of experience. It is right therefore that we devote a whole mini-symposium to this important subject. The mini-symposium begins with the discussion of the physiological changes associated with pregnancy. Practically every system of the body is affected by these changes, which are designed for the wellbeing of the fetus. These differences do mean that the pregnant mother may respond differently to the non-pregnant patient in a number of important ways, which may affect both general and regional anaesthetic techniques. It is vital, therefore, that the anaesthetist fully appreciates these changes in order to ensure the safety of the mother and fetus. Modern general anaesthesia is inherently very safe. When disaster strikes, however, it can have devastating consequences, particularly when the patient concerned is a young mother. In the quest for even greater safety more emphasis has been placed upon regional anaesthesia over the years and in many hospitals more Caesarean Sections are performed under regional blockade than under general anaesthesia. Neither technique is without its problems. There is, furthermore, considerable ongoing debate about the place of spinals and also combined spinals with epidurals. Two articles are therefore included in the mini-symposium which discuss the places of general and regional anaesthetic techniques for Caesarean Section.
Dr D. D. Moir, St David’s Perthshire PH7 3PJ, UK
Cottage,
Madderty
St Davids,
Crieff,
Currenr Anoesthesia and Crmcal Care (1991 I 2. 67 0
1991 Longman
Group
UK Ltd
67