Long description:

Pharmacology, Physiology, and Practice in Obstetric Anesthesia provides all the essentials of obstetric anesthesia in a straightforward, user-friendly format that avoids encyclopedic language and lengthy discussions, and is inclusive of other healthcare specialties and subspecialties including obstetrics, neonatal care, and more. Coverage spans the essentials of obstetrics as well as overlooked issues including obstetric pharmacology and physiology safe practice strategies, clinical concepts for vaginal delivery and C-section, high-risk pregnancy states and management of the complicated parturient, complications and medicolegal, fetus and newborn considerations, and guidelines, standards and statements related to obstetric anesthesia.

Pharmacology, Physiology, and Practice in Obstetric Anesthesia is the perfect reference for an interdisciplinary group of health professionals, policymakers, and researchers working and training in the field of obstetric anesthesiology

• Clearly addresses all the aspects of practice within the context of obstetrics, anesthesiology, and neonatal care
• Discusses new and relevant topics that are important to the field
• Provides up to date information in an accessible, user-friendly format

Table of Contents:

Contributors
About the editors
Preface

1. Physiological maternal adaptive changes during pregnancy, e.g., alterations of endometrium and decidua, menstruation, placenta, fetal membranes, placental hormones, morphological and functional fetal development
Amber N. Edinoff, Brooke Williams, Layne Landry, Elyse M. Cornett and Alan David Kaye

1. Introduction
2. Estrogen and progesterone in pregnancy
2.1 Progesterone
2.2 Estrogen
2.3 Decidualization
3. Physical changes in pregnancy
3.1 Cardiovascular system
3.2 GI system
3.3 Respiratory system
3.4 Skin
3.5 Sensory
3.6 Hematology
4. Pharmacologic changes in pregnancy
4.1 Absorption
4.2 Distribution
4.3 Metabolism
4.4 Elimination
5. Issues arising from the physiologic changes of pregnancy
5.1 Hypertensive disorders of pregnancy
5.2 Peripartum cardiomyopathy
5.3 Pulmonary changes in pregnancy
5.4 Postpartum depression
6. Conclusion
References

2. Anatomy of the reproductive tract: The placenta, uteroplacental circulation, anatomy, transfer of drugs, and respiratory gas exchange
Jessica Galey, Amy Zheng and Shobana Bharadwaj

1. Anatomy of the female reproductive tract
1.1 Organs
1.2 Innervation
1.3 Blood flow
1.4 Uterine blood flow changes during pregnancy
2. Anatomy of the placenta
2.1 Embryology
2.2 Macroscopic anatomy
2.3 Maternal vasculature
2.4 Fetoplacental vasculature
3. Placental physiology
3.1 Oxygen transfer
3.2 Carbon dioxide transfer
3.3 Acid base
3.4 Placental drug transfer
3.5 Common drugs used during pregnancy
3.6 Anesthetic drugs and placental transfer
4. Conclusion

3. Uterine blood flow and the effects of obstetric anesthesia
John Pallan, Amy Zheng, Jessica Galey and Shobana Bharadwaj

1. Introduction
2. Anatomy
3. Uteroplacental blood flow
4. Response to vasoactive agents
5. Mechanisms of changes
6. Determinants of uterine blood flow
7. Measuring uterine blood flow
8. Regional anesthesia and uterine blood flow
9. Doppler ultrasonography and uterine blood flow
10. General anesthesia and uterine blood flow
11. Effects of obstetric drugs
12. Conclusion

4. Perinatal pharmacology
Rucha Kelkar, Alina Smoleva, Therese Larson, Sahar Shekoohi and Alan David Kaye

1. Definition, background
2. Maternal factors
3. Placental factors
4. Basic fetal pathophysiology and risk factors
5. Fetal drug uptake, distribution, metabolism, and excretion
6. Related issues, historical trends
References

5. Parturient anesthesia assessment and evaluation
Hrayr Ghazaryan, Artush Grigoryan and Lincoln Frederick Arbogast

1. Introduction
2. History of anesthesia in obstetrics
3. Physiological changes in pregnancy
3.1 Cardiovascular
3.2 Respiratory
3.3 Gastrointestinal
3.4 Urinary
3.5 Endocrine
3.6 Hematologic
3.7 Coagulation
4. Preanesthesia evaluation of parturients
4.1 Past surgical history and anesthetic history
4.2 Past obstetric history
4.3 Past medical history
4.4 Physical examination
5. Evaluation of parturient with systemic disease
5.1 Cardiovascular diseases
5.2 Respiratory diseases
5.3 Anemias
5.4 Coagulation disorders
6. Endocrine diseases
6.1 Diabetes mellitus
6.2 Hyperthyroidism
6.3 Musculoskeletal disorders
6.4 Renal diseases
6.5 Liver diseases
7. Conclusion
References

6. How to create and maintain a safe and an efficient obstetric anesthesia practice
Anjum Anwar, Huma Wali and Hina Shamim

1. Introduction
2. Maternal care framework in the United States
3. Preanesthesia evaluation for obstetric patients
3.1 Background
4. Current state of affairs and challenges
4.1 Recommendations
5. Telemedicine
6. Patient education
7. Intrapartum care for parturient
7.1 Introduction
8. Challenges and recommendations
8.1 Medication shortages
8.2 Staffing and training/anesthesia workforce
8.3 Recommendations
8.4 Anesthesia management of high-risk pregnancies
8.5 Peripartum obstetric hemorrhage
8.6 Concept of the pregnancy heart team and cardiac obstetrics
8.7 Critical care in obstetrics
9. Enhanced recovery after CD
10. Process improvement to enhance patient safety in obstetric anesthesia
11. Handoffs and checklists
12. Simulation and team working in obstetric anesthesia
13. Racial disparities
14. Strategies to improve global inequities in obstetric anesthesia
15. Trauma informed care in obstetrics
References

7. Obstetric anesthesia consultation
Courtney Hood, Kristen L. Fardelmann and Benjamin Cobb

1. Indications for consultation
2. Components of consultation
3. Common indications for anesthesiology consultation
3.1 Anticoagulation
4. Thrombocytopenia
5. Placenta accreta spectrum (PAS)
6. Maternal cardiovascular disease
6.1 Interventions/ECMO
7. Spinal column/cord pathology, neurologic disease
8. Obesity
9. Opioid use disorder (OUD)
10. History of anesthetic complications
11. Consultation clinics
12. Conclusion
References

8. Obstetric management of labor and delivery, including preoperative assessment and basic standards for preanesthesia care
Huma Wali, Haneen Alnazzawi and Anjum Anwar

1. Introduction
2. CVD in the pregnant patient
3. Pregnancy counseling risk stratification
4. Mode and timing of delivery
5. Type of hospital and location within the hospital
6. Peripartum plan
7. The difficult airway in obstetrical anesthesia assessment
8. Preparation for difficult airway management
9. Difficult airway trolley
10. Difficult airway management
11. Simulation and training
12. Mental health and pregnancy
13. Management of psychiatric patients during pregnancy
14. Racial disparities in maternity care
15. Strategies for reducing disparities
15.1 Implementing protocols and safety bundles
16. Health care professionals’ education and communication
17. Outcome measurement, reviews, and community partnerships
18. Neuroobstetrics
19. Antenatal period/preconception
20. Intrapartum
21. Postpartum
22. Multiple sclerosis
23. Cerebrovascular diseases in pregnancy
24. Role of anesthesiologist in the management of stroke
25. Headache during pregnancy and postpartum
26. Evaluation of pregnant patients with headaches
27. Pregnancy and hematology
28. Iron-deficient anemia
29. Coagulation disorders
30. Hereditary coagulation disorders
31. Acquired coagulation disorders
32. Venous thromboembolism
32.1 Antepartum recommendations
32.2 Intrapartum recommendations
33. Respiratory diseases in pregnancy
34. Asthma
35. Respiratory failure
36. Obstructive sleep apnea
References

9. Fetal assessment and physiology
Mariana Montes, Chad T. Dean and Thomas James

1. Antenatal fetal assessment
2. Estimating gestational age
3. Routine ultrasonography
4. Evaluating the well-being of the fetus
4.1 Clinical assessment
5. Antepartum fetal testing
6. Fetal development and physiology
7. Fetal environment
8. Fetal cardiovascular system
9. Fetal respiratory system
10. Fetal hematologic system
11. Fetal neurologic system
12. Transition to the extrauterine environment
13. Physiologic changes in postnatal life
13.1 Cardiovascular and respiratory changes
14. Thermal regulation
15. Postnatal fetal assessment
16. APGAR score and umbilical cord gas and pH
References

10. Opioid analgesics in labor
Peter Louis Kovacs, Jayanth Dasika and Venkata Satya Lakshmi Damalanka

1. Introduction
2. Opioids
2.1 Mechanism of action
3. Pharmacokinetics
3.1 Absorption
3.2 Distribution
3.3 Biotransformation
3.4 Excretion
4. Effect on organ systems
4.1 Cardiovascular
4.2 Respiratory
4.3 Cerebral
4.4 Gastrointestinal
5. Plan for labor analgesia
6. Pharmacologic options for labor analgesia
7. Systemic analgesics
7.1 Opioid analgesia
8. Patient-controlled analgesia
8.1 Remifentanil PCA
8.2 Fentanyl PCA
8.3 Intermittent bolus opioid
8.4 Choice of opioid
8.5 Butorphanol
8.6 Fentanyl
8.7 Morphine
8.8 Meperidine
9. Regional analgesia
9.1 Neuraxial analgesia
9.2 Mechanism and site of action
9.3 Epidural opioids
9.4 Intrathecal opioids
10. Summary and conclusion
References

11. Mechanisms of labor pain and anesthesia in healthy parturients
Justin Swengel and Patrick McConville

1. Mechanisms of labor pain and its management
2. Nonpharmacologic treatment of pain
3. Pharmacologic techniques for labor pain control
3.1 Inhaled agents
3.2 Opioids
3.3 Neuraxial techniques
References

12. Nonopioid analgesia
Jayanth Dasika, Peter Louis Kovacs and Venkata Satya Lakshmi Damalanka

1. Nitrous oxide
2. Acetaminophen and nonsteroidal antiinflammatory drugs
3. Sedatives and analgesic adjuncts
References

13. Nonpharmacologic and alternative management of labor and delivery analgesia
David Gutman and Michael Marotta

1. Introduction
2. Water immersion
3. Biofeedback
4. Hypnosis
5. Acupuncture
6. Subcutaneous of intracutaneous sterile water injection
7. Manual/massage/reflexology
8. Conclusion
Reference

14. Local anesthetics and adjuvants in healthy obstetric patients
Jeffery Cao, Munfarid Zaidi, Lee Chang, Melissa Nikolaidis and Yi Deng

1. Introduction
2. Lidocaine
2.1 Mechanism of action
2.2 Clinical application
2.3 Side-effect profile
3. Ropivacaine
3.1 Mechanism of action
3.2 Clinical application
3.3 Side-effect profile
4. Bupivacaine
4.1 Mechanism of action
4.2 Clinical application
4.3 Side-effect profile
5. Chloroprocaine
5.1 Clinical application
5.2 Side-effect profile
6. Mepivacaine
6.1 Clinical application
6.2 Side-effect profile
7. Local anesthetic systemic toxicity
8. Adjuncts in neuraxial anesthesia
9. Epinephrine
10. Bicarbonate
11. Clonidine
12. Dexmedetomidine
13. Neostigmine
14. Magnesium
15. Experimental adjuncts
16. Opioids
17. Conclusion
References

15. Epidural anatomy and epidural anesthesia for labor and cesarean delivery
Fatoumata Kromah and Nicholas Malki

1. Introduction
2. Background
2.1 Epidural analgesia for labor and vaginal delivery
2.2 Epidurals for CD
3. Definition of topic
4. Issues related to this topic
5. Historical evolution/trends
6. Pathophysiology
6.1 Anatomy of the epidural space
7. Risk factors
8. Patient evaluation
9. Diagnosis
9.1 Medical History
9.2 Coagulation Status
9.3 Infection Control
9.4 Anatomical Considerations
9.5 Patient Preference and Informed Consent
9.6 Multidisciplinary Collaboration
10. Treatment
11. Anesthetic management
12. Pharmacology
13. Clinical issues or considerations
14. Prevention and self-care
15. Global impact and challenges
16. Future directions, novel treatments, and research studies
17. Summary/conclusion
18. Relevant images and tables
Abbreviations
References
Suggested readings


16. Neuraxial anesthesia for vaginal delivery
Kristin N. Bembenick, Angela Nguyen, Corrie Jackson, Sahar Shekoohi, Aaron J. Kaye, Alan D. Kaye and Harish Siddaiah

1. Introduction
2. Background
2.1 Epidural analgesia for labor and vaginal delivery
2.2 Epidurals for CD
3. Definition of topic
4. Issues related to this topic
5. Historical evolution/trends
6. Pathophysiology
6.1 Anatomy of the epidural space
7. Risk factors
8. Patient evaluation
9. Diagnosis
9.1 Medical History
9.2 Coagulation Status
9.3 Infection Control
9.4 Anatomical Considerations
9.5 Patient Preference and Informed Consent
9.6 Multidisciplinary Collaboration
10. Treatment
11. Anesthetic management
12. Pharmacology
13. Clinical issues or considerations
14. Prevention and self-care
15. Global impact and challenges
16. Future directions, novel treatments, and research studies
17. Summary/conclusion
18. Relevant images and tables
Abbreviations
References
Suggested readings

17. Neuraxial analgesia for cesarean delivery
Andrew Jensen, Kevin Chen, Melissa Nikolaidis and Yi Deng

1. Background
1.1 Cesarean delivery
1.2 Anesthesia with cesarean delivery
1.3 Trends in cesarean sections
2. The cesarean delivery
2.1 Indications
2.2 Contraindications
2.3 Degree of urgency
2.4 Risks
3. Anesthetic considerations for cesarean delivery: General anesthesia
3.1 Airway
3.2 Volatile anesthetics
3.3 Anterograde amnesia
4. Anesthetic considerations for the cesarean delivery: Neuraxial approach
4.1 Spinal
4.2 Epidural
4.3 Combined spinal and epidural
5. Acquiring the neuraxial blockade
5.1 Anatomic landmarks
5.2 Epidural placement
5.3 Procedural steps
5.4 Spinal placement
5.5 Procedural steps
5.6 Combine spinal-epidural placement
5.7 Procedural steps
5.8 Settings of placement
6. Diagnosing the coverage of neuraxial anesthesia
6.1 Appropriate coverage
6.2 Assessment using pinprick or temperature sensation
7. Troubleshooting inadequate coverage of neuraxial analgesia
7.1 Epidural management
7.2 Spinal management
8. Side effects of effective neuraxial block
8.1 Hypotension
8.2 Nausea
8.3 Shivering
9. The awake patient
9.1 Communication with parturient
9.2 Communication with other members of the medical team
9.3 Patient positioning
10. Global impact and challenges
11. Future directions, novel treatments, or research studies
References
Further reading

18. General anesthesia for normal, uncomplicated cesarean delivery: Indications and strategies
Fatoumata Kromah

1. Introduction
2. Background
3. Definition of the topic
3.1 General anesthesia
3.2 Cesarean delivery
4. Issues related to GA for the CD
4.1 Potential risks and side effects
4.2 Choice of anesthetic agents
4.3 RA versus GA
5. Historical evolution/trends
5.1 Early developments
5.2 Advent of RA
5.3 Shift from GA to RA
5.4 Current practices
6. Pathophysiology
6.1 Nervous system
6.2 Maternal physiology
6.3 Fetal physiology
6.4 Postoperative recovery
7. Risk factors
7.1 Maternal health conditions
7.2 Obstetric complications
7.3 Fetal health concerns
7.4 Specific perioperative risks
8. Patient evaluation
8.1 History taking
8.2 Physical examination
8.3 Relevant investigations
9. Diagnosis
10. Treatment
10.1 Preoperative preparation
10.2 Preoxygenation and preinduction
10.3 Induction and intubation
10.4 Maintenance and emergence
10.5 Postoperative care
11. Anesthetic management
11.1 Preoperative preparation
11.2 Intraoperative management
11.3 Postoperative management
12. Pharmacology
13. Clinical issues or considerations
13.1 Urgent versus elective CD
13.2 Patient preference
13.3 General health status
14. Prevention and self-care
15. Global impact and challenges
16. Future directions, novel treatments, and research studies
16.1 Improved monitoring techniques
16.2 Novel anesthetic agents
16.3 Enhanced recovery after surgery protocols
16.4 Telemedicine and digital health
16.5 Research on long-term impacts
17. Summary and conclusion
Abbreviations
References
Additional suggested readings

19. Airway management of the pregnant patient for labor and cesarean delivery
Moataz Maher Emara, Mohamed Maher Elwaraky, Laila Alhafez and Sally Hamdy Abdelaziz Ahmed

1. Incidence of GA and difficult airways in the obstetric population
2. Physiological changes during pregnancy: Implications on airway management
2.1 Respiratory parameters and gas exchange alterations
2.2 Airway obstruction and difficulty in intubation
2.3 Gastric emptying and aspiration risk
2.4 Pharmacological considerations
3. Evaluation and prediction of difficult airway
4. Maternal complications related to airway management
4.1 Aspiration pneumonitis
4.2 Bronchospasm
4.3 Post-extubation hypoventilation
4.4 Accidental awareness
5. Suggested protocol for airway management in pregnant women
5.1 Preparation of the parturient
5.2 Preparation of equipment and personnel
5.3 Positioning
5.4 Preoxygenation/apneic oxygenation
5.5 Rapid sequence induction
5.6 Induction and neuromuscular drugs
5.7 Cricoid pressure
5.8 Laryngoscopes
5.9 Tracheal extubation
6. Guidelines for difficult airway in pregnant women (UK-OAA/DAS)
6.1 Anticipated difficult intubation
6.2 Unanticipated difficult or failed intubation
6.3 Direct and indirect (video) laryngoscopy direct laryngoscopy
6.4 Obstetric Anesthetists’ Association and Difficult Airway Society guidelines
6.5 Other relative guidelines
References

20. Postoperative pain management for cesarean delivery
Antonio Gonzalez Fiol, P.J. McGuire, Kristen L. Fardelmann and Aymen Awad Alian

1. Acute pain after cesarean delivery
2. Neuraxial anesthesia and adjuvant drugs
2.1 Multimodal analgesia
2.2 Shared decision-making for pain management in the postpartum period
2.3 Opioid-sparing multimodal analgesia (OSMMA)
3. Opioid analgesics
4. Enhanced Recovery After Cesarean (ERAC)
4.1 Racial and ethnic disparities
5. General anesthesia
6. Local and regional analgesia techniques
7. Acute pain management for the patient with substance use disorder (SUD)
References

21. Postoperative sterilization surgery and anesthesia considerations
Melissa Nikolaidis, Jacy Gressen, Tommy Li and Yi Deng

1. Introduction: Postpartum birth control
1.1 The advantages of postpartum birth control preplanning
2. Methods for immediate postpartum contraception
2.1 Reversible contraception
2.2 Irreversible contraception
3. Current policies affecting postpartum sterilization
4. Postpartum sterilization procedure
4.1 Surgical considerations
4.2 Anesthetic considerations
5. Postsurgical sterilization pain management
6. Chapter summary
References

22. Anesthesia for assisted reproductive techniques
Fouzia Khalid and Amber Naz

1. Introduction
1.1 What is assisted fertilization
1.2 Ovum retrieval done through
1.3 Sperm collection
1.4 Patient preparation
1.5 Does ART procedure need anesthesia?
1.6 Conscious sedation
2. General anesthesia
2.1 Propofol
2.2 Thiopental
2.3 Ketamine
2.4 Etomidate
2.5 Inhalational anesthesia
2.6 Benzodiazepine
2.7 Dexmedetomidine
2.8 Opioids
2.9 Non-opioid analgesic
2.10 Antiemetics
2.11 Neuraxial anesthesia
2.12 Paracervical block
2.13 Patient controlled analgesia
2.14 Newer techniques
2.15 Complications associated with assisted fertilization
2.16 Ovarian hyperstimulation syndrome
2.17 Ectopic pregnancy
2.18 Multiple gestation
References

23. Anesthesia considerations for pregnant patients with cardiovascular disease
Islam Mohammad Shehata Elsayed, Yasmeen Ahmed Mohamed Taha, Hala Mostafa Goma and Nesrine Abdel Rahman Elrefai

1. Cardiac diseases in pregnancy
2. Common risk factors of cardiac disease in pregnancy
3. Types of cardiac diseases in pregnancy
4. Risk classification of the patient with cardiac diseases
5. General considerations of cardiac parturients
6. Preoperative evaluation of cardiac pregnant patient
7. History
8. Preoperative clinical assessment
8.1 Cardiac tests during pregnancy
9. Preoperative considerations for specific cardiac lesions
9.1 Congenital heart diseases
9.2 Arrhythmia
9.3 Prosthetic heart valves
10. Rheumatic valvular disease
10.1 Mitral stenosis (MS)
10.2 Mitral or aortic regurgitation
10.3 Myocardial infarction
11. Peripartum cardiomyopathy
11.1 Cardiac tests for diagnosis of peripartum cardiomyopathy
12. Preoperative preparation of cesarean section
12.1 Monitoring for cesarean delivery
13. Anesthesia techniques
13.1 Regional anesthesia
14. Anticoagulant therapy considerations
14.1 The cardiovascular effects of regional anesthesia
14.2 The type and severity of cardiac illness
14.3 How to conduct safe neuraxial anesthesia
15. Postpartum care
16. Conclusion
References

24. Anesthesia considerations for pregnant patients with lung disease
Adam Lin Wendling and Clinton Pillow

1. Introduction
2. Background
3. Issues related to this topic
4. Historical evolution/trends
5. Pathophysiology
6. Risk factors
6.1 Preexistent pulmonary disease
6.2 Acquired pulmonary disease
7. Patient evaluation
7.1 History
7.2 Physical
7.3 Confirmatory tests
8. Diagnosis
8.1 Obstructive lung disease
8.2 Restrictive lung disease
8.3 Respiratory tract infections
8.4 ARDS
9. Treatment
9.1 Asthma
9.2 Cystic fibrosis
10. Anesthetic management
10.1 General principles
11. Global impact and challenges
12. Future directions, novel treatments, or research studies
13. Summary and conclusion
References

25. Anesthesia considerations for patients with renal, hematologic, connective tissue, and immunologic diseases
Rucha A. Kelkar, Alexandra D. Dautel, Lillian V. Lauck, Michael J. Quintana, Sahar Shekoohi and Alan David Kaye

1. Introduction
2. Renal considerations
2.1 Definition, background, related issues, historical trends
2.2 Pathophysiology
2.3 Risk factors
2.4 Patient evaluation, diagnosis, treatment
2.5 Anesthetic management, pharmacology
3. Hematologic considerations
3.1 Definition, background, related issues, historical trends
3.2 Pathophysiology
3.3 Risk factors
3.4 Patient evaluation, diagnosis, treatment
3.5 Anesthetic management, pharmacology
3.6 Clinical issues/considerations, prevention, self-care
3.7 Global impact and challenges
4. Connective tissue considerations
4.1 Definition, background, related issues, historical trends
4.2 Pathophysiology
4.3 Anesthetic management and risk management
4.4 Patient evaluation, clinical issues/considerations, prevention
5. Immunologic considerations
5.1 Definition, background, related issues, historical trends
5.2 Pathophysiology
5.3 Risk factors
5.4 Patient evaluation, diagnosis, treatment
5.5 Anesthetic management, pharmacology
5.6 Clinical issues/considerations, prevention, self-care
5.7 Global impact and challenges
6. Future directions, novel treatments, or research studies
7. Summary and conclusion
References

26. Anesthesia considerations for parturients with endocrine disorders
Evan Nicholas Lian, Asher Le and Aladino De Ranieri

1. Introduction
2. Diabetes mellitus
2.1 Anesthetic implications
3. Thyroid disease
3.1 Hyperthyroidism
3.2 Hypothyroidism
3.3 Temperature regulation
4. Pituitary disease
4.1 Acromegaly
5. Adrenal disease
5.1 Cushing syndrome
5.2 Adrenocortical insufficiency
5.3 Pheochromocytoma
References

27. Anesthetic considerations for patients with neurologic disorders in pregnancy
Philip Rubin and Lisa Leffert

1. Introduction
2. Background
3. Case