Anestesi pada obstetri by ArdiPramono

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									Anestesi pada Obstetri

      Ardi Pramono
                Case
Seorang ibu hamil 39 minggu, mulai
merasakan kenceng-kenceng teratur.
Diperiksa oleh dokter kandungan
dinyatakan sudah mulai buka 2 cm.
Karena takut nyeri sewaktu melahirkan,
maka dokter menyarankan pemasangan
LEA (labour epidural analgesia). Tetapi
dalam proses melahirkan, ternyata harus
di lakukan cesar.
           Stage of labor
1st stage: regular contraction and dilatation
 pain is carried by visceral aff. fibers
(T10-L1).
2nd stage: full dilatation, ends w. delivery
of the infant  pain from stretching birth
canal, vulva, perineum (S2-S4)
3rd stage: delivery placenta
Stage proses kelahiran jenin
      Physiological changes
Increased:
– Hematological: vol. (40-50%), total blood vol. (25-
  40%), dilutional anemia (hmt 31.9-36.5%)
– Cardiovascular: CO (30-50%), decreased SVR
  (35%), HR (15-20 bpm)
– Pulmonary: minute vent.(50%), decreased. FRC
  (20%), airway edema, dec PaCO2 and PaO2
– Gastrointestinal: prolonged emptying, dec. lower
  esophageal spinc. Tone
– Altered drug responsed: decreased requirement
  inhaled and local anesthetic
Perubahan fifiologis pada ibu hamil
     Fetal heart monitoring
Beat to beat variability: normal 110-160
bpm  be careful for fetal distress (due to
arterial hypoxemia, acidosis
Early decelerations: begin onset urine
contractions  head contraction
Late decelerations: after uterine
contraction  uteroplasental insuff.
Variable decelerations: caused by
umbilical cord compression
Aortocaval compression syndrome
Caused by impaired venous return
Symptoms: nausea, vomiting,
hypotension, tachycardia, sweating
Prevented by laterally position
Medications used during labor
Vasopressors: ephedrin, phenylephrine
Oxytocin
Tocolytics: terbutalin
MgSO4
Anesthesia for labor and delivery
Common pain medication: meperidine (25-50
mg iv), mo (2-5 iv), fentanyl (25-50 ug iv).
Lumbar epidural blockade:
– Epidurals (in active labor 5-6 cm in nullipara; 3-4 cm
  in multipara)
Intrathecal opioid in significant pain: use
fentanyl, meperidine, sufentanyl
Spinal anesthesia (saddle block) for forceps
delivery and repair traumatic laceration of vagina
and rectum
Combined spinal and epidural labor
Paracervical block  at fornix of vagina
Pudendal block
General anesthesia (rare)
Ibu hamil perlu ketenangan menghadapi pemberian analgesi epidural
Salah satu posisi pemberian analgesi lumbal
   Anesthesia for cesarean
General anesthesia
Regional anesthesia (spinal or epidural)
   Anesthesia for curretage
Case:
– Ab. Inkompletus
– Molla hidatidosa
– Blighted ovum
– PUD (perdarahan uterus disfungsional)
Prinsip: Sedasi dan anlegetik ketamin,
petidin, midazolam
Ibu hamil memerlukan ketenangan seperti air yang jernih
   Alhamdulillah..

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