Handbook of Obstetric Anaesthesia

This book is designed as a guide to practical obstetric anaesthesiaand aims to be a quick reference for trainees and consultantanaesthetists working in this area. The contents section showsclearly the chapters together     

Quantitative Assessment of Placenta Transfer of Fazadinium in Obstetric Anaesthesia

Fazadinium, 1 mg/kg, was administered to 16 women undergoing general anaesthesia for casearean section or vaginal delivery with forceps. Fazadinium serum levels were measured fluorimetrically in samples of maternal venous blood and umbilical arterial and venous blood obtained at the time of delivery. The umbilical to maternal ratio of venous fazadinium averaged 20% and was not influenced by the interval between induction and delivery. A lower concentration was found in the umbilical artery, and the arterial to venous cord blood concentration ratio was about 75% suggesting foetal drug uptake. In all cases, Apgar scores were normal at the fifth minute. It is concluded that there is a placental transfer of fazadinium; however, this transfer is limited and the risk of paralysis of the newborn appears unlikely after a single intubating dose of 1 mg/kg administered to the mother.     

Laryngeal Oedema as an Obstetric Anaesthesia Complication: Case Reports

Three cases of laryngeal oedema leading to endotracheal intubation dificulties in obstetric anaesthesia are described. The first case occurred immediately postpartum in a patient who developed a swollen face from strenuous bearing down efforts in the second stage of labour. The other two cases were patients with severe pre-eclampsia including marked generalized oedema. The possibility of the occurrence of laryngeal oedema with resultant endotracheal intubation dificulties in obstetrics should be remembered when endotracheal intubation is considered to avoid the hazard of acid aspiration. The authors prefer the use of regional anaesthetic techniques (if not contraindicated) in obstetrics, and emphasize the use of prophylactic methods to minimize the risk of acid aspiration in connection with general anaesthesia, particularly where endotracheal intubation may be diflicult.