Fundamentals of Anaesthesia and Acute Medicine Anaesthesia for Obstetrics and Gynaecology Edited by Robin Russell Consultant Anaesthetist and Honorary Senior Clinical Lecturer, Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford Fundamentals of Anaesthesia and Acute Medicine Anaesthesia for Obstetrics and Gynaecology FUNDAMENTALS OF ANAESTHESIA AND ACUTE MEDICINE Series editors Ronald M Jones, Professor of Anaesthetics, St Mary’s Hospital Medical School, London, UK Alan R Aitkenhead, Professor of Anaesthesia, University of Nottingham, UK Pierre Foex, Nuffield Professor of Anaesthetics, University of Oxford, UK Titles already available: Cardiovascular Physiology (second edition) Edited by Hans-Joachim Priebe and Karl Skarvan Clinical Cardiovascular Medicirie in Aiiaesthesia Edited by Pierre Coriat Iritensive Care Medicine Edited by Julian Bion Management of Acute arid Chronic Pain Edited by Narinder Rawal Neuro-Anaesthetic Practice Edited by H Van Aken Neuromuscular Transmission Edited by Leo HDJ Booij Paediatric Intensive Care Edited by Alan Duncan Forthcoming: PhamiacologV of the Critically Ill Edited by Maire Shelly and Gilbert Park 11 Fundamentals of Anaesthesia and Acute Medicine Anaesthesia for Obstetrics and Gynaecology Edited by Robin Russell Consultant Anaesthetist and Honorary Senior Clinical Lecturer, Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford c ' BMJ Publishing Group 2000 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise, without the prior written permission of the publishers. First published in 2000 by the BMJ Publishing Group, BMA House, Tavistock Square, London WClH 9JR www.bmibooks.com British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN 0-7279-1276-3 Typeset by Phoenix Photosetting, Chatham, Kent Printed and bound by J W Arrowsmith Ltd, Bristol Contents Contributors Foreword Preface 1 Maternal changes in pregnancy 2 3 4 Regional analgesia and anaesthesia 5 General anaesthesia for obstetrics 6 7 Medical emergencies in pregnancy 8 Postnatal assessment 9 Anaesthesia for gynaecological surgery JAMES ELDRIDGE The effects of anaesthesia and analgesia on the baby Pain relief in labour: non-regional JACKIE PORTER MARK SCRUTTON MICHAEL PAECH RICHARD VANNER The parturient with coexisting disease PHILIPPA GROVES, MICHAEL AVIDAN CAROLINE GRANGE ROBIN RUSSELL KYM OSBORN, SCOTT SIMMONS vi vii ... Vlll 1 30 79 109 178 20 1 239 28 1 303 Index 347 V Contributors Michael Avidan Clinical Lecturer, Department of Anaesthetics, King’s College Hospital, London, UK James Eldridge Consultant Anaesthetist, Department of Anaesthetics, Queen Alexandra Hospital, Portsmouth, UK Caroline Grange Consultant Anaesthetist, Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK Philippa Groves Consultant Anaesthetist, Department of Anaesthetics, King’s College Hospital, London, UK Kym Osborn Staff Specialist, Department of Women’s Anaesthesia, Women’s and Children’s Hospital, Adelaide, South Australia Michael Paech Staff Specialist, Department of Anaesthesia, King Edward Memorial Hospital for Women, Perth, Western Australia Jackie Porter Consultant Anaesthetist, Department of Anaesthetics, St Thomas’ Hospital, London, UK Robin Russell Consultant Anaesthetist and Honorary Senior Clinical Lecturer, Nuffield Depart- ment of Anaesthetics, John Radcliffe Hospital, Oxford, UK Mark Scrutton Consultant Anaesthetist, Department of Anaesthetics, St Michael’s Hospital, Bristol, UK Scott Simmons Head of Department, Department of Women’s Anaesthesia, Women’s and Children’s Hospital, Adelaide, South Australia Richard Vanner Consultant Anaesthetist, Department of Anaesthetics, Gloucestershire Royal Hospital, Gloucester, UK vi Foreword The Fundamentals of Anaesthesia and Acute Medicine series The pace of change within the biological sciences continues to increase and nowhere is this more apparent than in the specialties of anaesthesia, acute medicine, and intensive care. Although many practitioners continue to rely on comprehensive but bulky texts for reference, the accelerating rate of biomedical advances makes this source of information increasingly likely to be dated, even if the latest edition is used. The series Fundamentals of Anaesthesia and Acute Medicine aims to bring to the reader up-to-date and authoritative reviews of the principal clinical topics which make up the specialties. Each volume will cover the fundamentals of the topic in a comprehensive manner but will also emphasise recent developments of controversial issues. International differences in the practice of anaesthesia and intensive care are now much less than in the past and the editors of each volume have commissioned chapters from acknowledged authorities throughout the world to assemble contributions of the highest possible calibre. Three volumes will appear annually and, as the pace and extent of clinically significant advances vary among the individual topics, new editions will be commissioned to ensure that practitioners will be in a position to keep abreast of the important developments within the specialties. Not only does the pace of advance in biomedical science serve to justify the appearance of an international series of this nature but the current awareness of the need for more formal continuing education also underlines the timeliness of its appearance. The editors would welcome feedback from readers about the series, which is aimed at both established practitioners and trainees preparing for degrees and diplomas in anaesthesia and inten- sive care. RONALD M JONES PIERRE FoEx ALAN R ATKENHEAD vii Preface Obstetric anaesthesia continues to increase in popularity whilst advances in gynaecological surgery have implications for anaesthetic practice. This book is possibly the first text dedicated to both these aspects of women’s anaesthesia. Obstetric anaesthesia is rewarding in nature but appropriate training of correct technique can only increase the safety of both mother and baby during childbirth and is perhaps of greater significance. For those involved in the anaesthetic care of women undergoing gynaecological procedures there is now an increasing amount of laparoscopic work and an expansion in outpatient surgery. This book is aimed primarily at anaesthetists in train- ing, with individual authors attempting to provide a thorough grounding of principles and practice of anaesthetic management based on current evi- dence. Due to its size the book is not a comprehensive review of all aspects of women’s anaesthesia, but it should offer readers a helpful foundation on which to base their clinical practice. ROBIN RUSSELL ... Vlll