OBSTETRICS

SURGERY
ANESTESHIA

Oleh :

DEFINITION
Anesthesia : an
not/without
aesthatos
Perception/Ability to feel
Anestesi = an action to relieve
pain when performing surgery
and various other procedures
that cause pain in the body

Type of
anesthesia
Local Anesthesia

Central Block
Spinal Block
Epidural Block
Caudal Block

Regional
Anesthesia

General
Anesthesia

Perifer Block:
Pleksus Brakialis Block
Aksiler Block
Analgesia Regional IV
etc

PRINCIPAL OF ANESTHESIA
1. Characteristic of analgesia is
strong enough
2. Does not cause
psychological trauma to mother
3. Low toxicity to the mother
and baby safe
4. Do not depress the fetus
5. Muscle relaxation is
achieved without uterus
relaxation

Anesthesia Preparation
Preparation of the mother
To prevent aspiration
- Active gastric emptying by
suction
- Neutralization of gastric acid
to give magnesium trisilicate
-Reducing the production of
gastric acid with drugs
To avoid hipovolemic
- Installation of infusion
- Provides blood
uterotonic drugs
Preparation of the Fetal
infant resuscitation equipment
-The infant warmers

Anesthesia is likely to cause

vomiting
Vomiting occurs most often at
the time of induction and time
will regain consciousness
Can be active vomiting (vomit)
or passive flow (regurgitation
due to weak sphincter cardia)
Vomit will easily enter the
lungs through the trachea
(aspiration into the lungs)
Pulmonary aspiration cause
lung damage high mortality
rate.

Mencegah muntah
Mengosongkan lambung
puasa cukup
memasang pipa lambung,
dihisap sampai kosong
Menghilangkan refleks
muntah
induksi cepat, sadar kembali
(recovery cepat)
jaga nafas, hipoventilasi
sering memicu muntah
Melindungi trachea
intubasi trachea dengan ETT
+ cuff
posisi kepala lebih rendah
(head down

PREMEDIKASI
Kebanyakan obat anestesi
bisa mencapai janin
Hindari pemberian obat-obat
sedasi dan narkotika karena
berakibat depresi pada janin
Pemakaian pengering/drying
agent ( SULFAS ATROPIN)
0,01 MG / KG
Pemberian Mg-Trisilikat

Local Anesthesia

Direct Infiltration around the Injury

nervus pudendus block

Blok nervus pudendus

Complication

Dizziness and
lightheadedness
tinnitus
strange behavior
convulsions
There is a breathing disorder
Intoxication on the
cardiovascular system, the
early symptoms of
hypertension and
tachycardia, followed by
hypotension and bradycardia.

Anastesi Regional
Analgesi/blok epidural (lumbal)

Spinal Anesthesia

Conduction anesthesia to inhibit pain signals

by giving a local anesthetic into the
subarachnoid space using a special needle.
Advantages: simple
technique, rapid induction,
fetal exposure to the drug
minimal so that the
incidence of depression
fetus avoided, the patient is
awake, reduce the danger
of aspiration.

Disadvantages: high
incidence of hypotension,
nausea and vomiting
intrapartum, the
possibility of a headache
after dural puncture,
limited working time

Indication

contraindications
ABSOLUTE
Patients refusal
Inability to cooperate
Increased intracranial pressure
Infection
Severe coagulopathy
Severe hypovolemia
Inadequate training

RELATIVE
Systemic maternal infection
Preexisting neurological deficiency
Mild or isolated coagulation
abnormalities
Relative (and correctable)
hypovolemia

complication

Trauma permanent neurologic

Cauda equina syndrome
Spinal hematoma
Arachnoiditis
Meningitis
PDPH
High spinal
Cardiovascular disorders

Epidural anesthesia
Provides

excellent pain relief reducing

maternal catecholamines
Ability to extend the duration of block
to match the duration of labor
Blunts hemodynamic effects of uterine
contractions: beneficial for patients
with preeclampsia.

 Advantages:
Possible risk of
aspiration smaller
The incidence and
severity of maternal
hypotension smaller
The epidural can be
used for a longer
operation
Depression in the
fetus is reduced
mother remains
conscious

Disadvantages:
Mechanical
difficult
Start slow work
It takes the
number of local
anesthetic drugs
more
It could happen
Post Dural
Puncture
Headache

contraindications
The patient refused
The presence of
coagulation factor
disorders
Infection in the
epidural catheter
Hypovolaemia
There is an
increase in
intracranial pressure
Allergy to local
anesthetic

Epidural complications
Trauma permanent neurologic
Cauda equina syndrome
Spinal hematoma
Arachnoiditis
Meningitis
PDPH
High spinal / high spinal block
Cardiovascular disorders
(hypotension)

Standard Technique of
LEA

Comparison of Sitting and Lateral Positions for

Performing Spinal or Epidural Procedures
Sitting
Advantages
Midline easier to identify in obese
women
Obese patients may find this position
more comfortable

Lying (left lateral)

Can be left unattended without risk
of fainting.
No orthostatic hypotension
Uteroplacental blood flow not
reduced (particularly important in the
stressed fetus)

Disadvantages
Uteroplacental blood flow decreased May he more difficult to find the
Orthostatic hypotension may occur
midline in obese patient
Increased risk of orthostatic
hypotension if Entonox and pethidine
have been administered
Assistant (or partner) needed to
support patient

Combined spinal epidural (CSE)

Initial

reports: two interspace technique-epidural

followed by spinal
Later evolution of CSE in the direction of needle
through needle technique
Postdural puncture headache: 1% or less incidence for
CSE with small bore atraumatic needles.
Used when require the speed and density of a spinal
anesthetic with the flexibility of prolonging the block by
supplemental increments of local anesthesia via the
epidural catheter
Complications: as mentioned for spinals and epidurals

Advantages of CSE for Labor

Analgesia
Rapid

onset of intense analgesia (the

patient loves you immediately!)

Ideal

in late or rapidly progressing labor

Very

low failure rate

Less

need for supplemental boluses

Minimal

motor block (walking epidural)

Combined Spinal epidural

video

General anesthesia

Used when
Patient refuses regional technique
Regional technique is

contraindicated
Emergency C/S when there is
inadequate/absent regional
analgesia and to delay will cause
undue risk to the fetus / mother

Complications:
Failed intubation
Failed ventilation causing death

or neurological injury
Awareness
Aspiration pneumonia

Anesthesia: Effects on the fetus

Avoid hypotension, hypoxia, acidosis,

hyperventilation
Limit time between uterine incision and
delivery to less than 3 minutes
Infants exposed to GA have lower Apgar
at one minute but no difference at 5 mins
No significant alteration in
neurobehavioral scores with regional
techniques

Obat yang dipakai pada Anestesi

umum

Tahap induksi diberikan pentothal

atau propofol
Tahap intubasi succinylcholin dan
rumatan dengan tracurium, N20/02 dan
halothan dosis kecil
Post op setelah bayi lahir diberikan
ergometrin iv dan oxitocin drip dan
anestesi dilanjutkan seperti biasa.

Kesimpulan