By David H. Chestnut MD, Cynthia A Wong MD, Lawrence C Tsen MD, Warwick D Ngan Kee, Yaakov Beilin MD, Jill Mhyre MD
"...a complete and modern, sleek reference text." via British magazine of Anaesthesia, may possibly 2015
"Chestnut and his seventy nine specialist participants have once more published a present consultant to obstetric anesthesia that proves invaluable to either junior freshmen and subspecialty providers." via Canadian magazine of Anesthesia, Apr 2015
- Emphasizes the therapy of the fetus and the mum as separate sufferers with distinctive must make sure the program of recent ideas of care.
- Delivers contributions from many leaders within the fields of obstetric anesthesia and maternal-fetal medication from around the world.
- Offers ample figures, tables, and packing containers that illustrate the step by step administration of an entire variety of scientific situations.
- Presents key aspect summaries in each one bankruptcy for fast, handy reference.
- Stay present at the newest developments and developments with sweeping updates and new chapters on themes similar to sufferer protection and crew technique, transthoracic echocardiography and noninvasive dimension of cardiac output in obstetric sufferers, psychiatric problems while pregnant, neurologic accidents, and more.
- Prevent and plan for capability issues associated with the advancing age of pregnant ladies. an intensive, state-of-the artwork dialogue of "critical care of obstetric sufferers" equips you to deal with any specific issues for this expanding phase.
- Know precisely the best way to continue. An abundance of tables and bins illustrate the step-by-step administration of an entire variety of scientific scenarios.
- Choose the simplest medications to be had while adhering to the latest directions for obstetric anesthesia.
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Additional resources for Chestnut's Obstetric Anesthesia: Principles and Practice
227-229 The dependence on the sympathetic nervous system returns to that of the nonpregnant state by 36 to 48 hours postpartum. ANESTHETIC IMPLICATIONS Positioning Aortocaval compression, decreased blood pressure and cardiac output, and impairment of uteroplacental blood flow occur when a pregnant woman is placed in the supine position. 230-232 Therefore, after 20 weeks’ gestation, the supine position should be avoided and the uterus should be displaced to the left by placement of a wedge underneath the right hip or by tilting the operating table to the left (Figure 2-12).
B, Pregnant. There is a marked increase in lumbar lordosis and a narrowing of the interspinous spaces during pregnancy. (Modified from Bonica JJ. Principles and Practice of Obstetric Analgesia and Anesthesia, Volume 1. ) Pregnant patients show decreased local anesthetic dose requirement in the first trimester. 256 Pregnant women exhibit a more rapid onset and a longer duration of spinal anesthesia than nonpregnant women who receive the same dose of local anesthetic. 263 Spinal dose requirements change rapidly in the postpartum period, with segmental dose requirements returning to those of nonpregnant women within 24 to 48 hours264 as spinal CSF volume expands with the relief of vena caval compression.
The hormonal changes of pregnancy may also play a role. Relaxin, a polypeptide hormone of the insulin-like growth factor family, is associated with remodeling of collagen fibers and pelvic connective tissue. The primary source of circulating relaxin is the corpus luteum; the placenta is a secondary source. 206 Women who develop low back pain during pregnancy may avoid subsequent pregnancy to prevent recurrence. 207 In the majority of patients, low back pain during pregnancy responds to activity and postural modification.