1. General Anesthesia - used only if a difficult delivery is suspected.
Disadvantages: It may interfere with maternal-infant bonding.
It can cause respiratory distress to the infant.
Commonly used agents:
a. Ether - causes severe nausea in mother.
b. Nitrous oxide - “laughing gas”, use with contractions after dilatation.
c. Cyclopropane - provides rapid induction; used in emergency situation; should not be used with ergot derivatives and oxytocin.
d. Trilene - self-administered by mask.
e. Pentothal - IV administered, providing rapid induction.
2. Regional Anesthesia - used to block nerves carrying sensations to the uterus and the pelvic area.
Commonly used agents: Pontocaine (tetracaine), Marcaine (bupivacaine), Xylocaine, Novocaine (procaine).
Nerve root blocks:
- Types:
a. Epidural
b. Saddle - “low spinal”
- Use: usually given on latter part of the first stage to block sensations of contractions.
- Patient Care Management:
a. Have the patient void before initiating procedure.
b. Take baseline vital signs before procedure.
c. Position patient on left side with head flexed and knees drawn up or in a sitting position.
d. Check BP as soon as anesthesia was administered.
e. Keep mother in a side-lying position.
f. Check BP q5 until stable.
g. Check for spinal headache.
h. Use safety precautions.
3. Peripheral Nerve Blocks
- Types:
a. Paracervical - done during the transition phase. It anesthetizes lower uttering segment, cervix, and vagina.
b. Pudendal - done at full dilatation anesthetizing the vagina and perineum.
c. Local infiltration - anesthetizes perineum used for episiorrhaphy.
