Anesthesia in

Pregnancy and
Childbirth
Preliminary Anesthesia
Reruired for delivery without pain,pliers or vacuum extraction,
caesarean section or other delivery complication action.
• Method anesthesia :minimum depress fetal anesthesia safe and
comfortable for the mother, the operator can work optimally
• Complication for mother
• Adverse effects on the fetus
Factors that cause fetal asphiyxia
1. Intravenous anesthetic drugs.
Induction: pentotal, propofol, ketamine.
Sedation: diazepam, midazolam.
Analgesics: opioids (pethidin, morphine, fentanyl).
2. Inhalation anesthetics.
The effect on the baby depends on the dose given(halotan,
enfluran, isofluran,sevofluran)
1. Muscle relaxant drugs.
For ETT intubation and relaxation so that the operator is working.
No effect to the fetus because it can not pass the placental barrier.
2. Local Anesthesia drug
Tehnik anesthesia regional anesthesia drug use is a spinal block and
epidural block. The direct effect of the baby depends on the technique
and the dose of local anesthetic drugs in use.. Obat yg sering digunakan
adalah bupivakain 0,5% dan ropivakain 0,75%.
Komplikasi pada ibu

Pulmonary Aspiration
Aspiration of gastric fluid into the lungs due to regurgitation or
muntah.Hal is due ↓ esophageal sphincter tone, which slow gastric
emptying, gastric acid production, gastric pressure ↑the complication
can held when induction,intubation,and ectubation.
• Respiratory disorders.
Occur because of trauma to the airway during endotracheal
intubation, difficult intubation, hypoventilation from opioid drugs or
anesthesia
• Cardiovascular disorders.
Form of hypotension due to severe bleeding that suddenly,
obstruction aortokava, sympathetic blocks for spinal anesthesia and
epidural, vasomotor depression due to the anesthesia that in.
Local Anesthesia
• Choice for cesarean section because it can be done, the effect of
sympathetic blocks more easily controlled, oxygenation and
ventilation is guaranteed. Rarely do to relieve labor pain, because the
number of small and uneconomical satisfaction
• This technique is recommended in cases of fetal distress,
hypovolemia (shock). Must be careful in case of difficult intubation,
pre-eclampsia and eclampsia, a full stomach (fasting <6 hours).
Anestesia Regional
• Contra indications spinal and epidural blocks are:
- Infection of the surrounding area punctures.
- - Disorders of blood clotting.
- - Hypovolemia.
Complication

- Hypotension, due to sympathetic block → vasodilatation. - Impaired

respiration, due to respiratory muscle paralysis because the block is
too high, the central depression of breath due to hypoperfusion in
trunk of brain
- Vomiting, due to visceral manipulation tools, or hypoperfusion in
the brain stem.
- Another complication is a headache, especially when sitting or
standing position, and will decrease when lying down.
Benefit
1. Danger of aspiration smaller, because the patient is awake.
2. Physiological relationship between mother and baby interwoven
faster.
3. The effects of drugs on the fetus is smaller.
4. The amount of bleeding because fewer actions.
5. mobilization and begin feeding sooner.