Lectures , Obstetric anesthesia for dummies


these are lectures on obstetric anesthesia, reasonable pain management

watch them, and talk to me after , I ll be happy to answer your questions

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Phrenic nerve

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How fast should i inject spinal hyperbaric solution ?

First , this is regular isobaric solution , see how it spreads, it does not go down or up , it just sits there


i should inject SLOWLY—0,5 ml over 1 min, then it drips to the bottom

if i do it too fast—thats what happens—it ends up too high(its the same 0,5ml hyperbaric solution ,but injected in 20 sec)



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Barbarians strike again !!! Oxygen by mask during fetal distress


Usual practice  on Labor and Delivery floor  during FHR decelerationg is to put O2 mask on the mother and turn O2 to 10 liters. It’s done to increase O2 delivery to the fetus. Here we ask question —does it work? or even better, can it work?

Formula for O2 content in blood

O2 content=(Hgb x 1.36  x  SaO2 )+(0,0031 x PaO2)

if we ignore second part of the equasion –its too small, insignificant ( oxygen dissolved in blood),  we see that  O2 content depends on SaO2. Healthy mothers in labor have SaO2  100%  .  So by putting O2 mask on the face we can NOT increase O2 content and delivery O2 to the fetus.

It is physiologicly impossible.

Barbarians strike again!!!

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ASA guidelines for monitoring …are they reasonable?


Main fear of any anesthesiologist working in OB is  (besides aspiration on c-section  with GA)—respiratory depression  after intrathecal or epidural morphine.Red flag goes up in anesthesiologist brain  when somebody says “SPINAL MORPHINE”. Scariest  thing is  that respiratory depression is delayed (8-12h) , sneaky thing. And ASA guidelines are —monitor every 1 hour(in busy place its enormous burden for nurses).Outcome of all that —intrathecal or epidural morphine(unquestionably  the best pain relief after c-section) is used maybe only in 40% hospitals in US.

We desided to reflect on fears and analyse ASA guidelines.

Facts —-respiratory depression in OB is very rare, up to 2010 in 14.000.000 cases —no death from respiratory depression in OB after  intrathecal morphine. It happens , but very rare.

(to be followed)

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How does epidural space look like?

like this

Green is epidural , not green –not an epidural.

and some shots with explanations:


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How to keep epidural catheter for 3 days?

For pain relief post c-section we use Dyramorph(2mg bid) or Dilaudid(0.5mg bid) thru epidural catheter.But how to keep epidural catheter in the back for 3 days and not to loose it and not to have infection?

2 conditions

1)using Chlorhexedine for prep —it will give 48 h antiseptic protection, skin will be clean  , not infiltrated , no pus, if i use iodine—will be some local infiltration, painfulness on palpation, pus around catheter. Iodine creates sterile condition, but not lasting.

2) taping is important–Tegaderm will not stay–its plastic , sweat will disloge it from inside.Wound will not heal that good–you do not put plastic cover over surgical wound . In order to heal wound should be dry. We use Benzoin and perforated tape.

its Medipore 3M tape—but it will NOT stay unless you use benzoin.Only one little piece is needed.

Final result looks like this:(image to follow)

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if i click in wikipedia for epidural that what i see

Whats wrong with this picture?

1)prep is iodine—-Chlorhexidine is better

2)catheter is nylon—wired catheters are better

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