Page 49 - Part 2 Anesthesiology Common Risk Issues

SVMIC Anesthesiology: Common Risk Issues

is obese, the early insertion of a neuraxial catheter should be

considered to reduce the need for general anesthesia if an
emergent procedure becomes necessary. In these cases, the

insertion of a neuraxial catheter may precede the onset of
labor or a patient’s request for labor analgesia. This decision

should be made on a case-by-case basis with the input of the
entire obstetric team. While continuous epidural infusion may

be used for effective analgesia for labor and delivery, an opioid
may be added to reduce the concentration of local anesthetic,

improve the quality of analgesia, and minimize the motor
block. Use diluted concentrations of local anesthetics with

opioids to produce as little motor block as possible. Single-
injection spinal opioids may also be used with or without local

anesthetics to provide effective, although time-limited, analgesia
for labor when spontaneous vaginal delivery is anticipated. If

the anesthesiologist is concerned that labor may last more than
the analgesic effects of the spinal drugs chosen, or if there is a

reasonable possibility of operative delivery, a catheter technique
instead of a single-injection technique may be used. The use

of pencil-point spinal needles instead of cutting-bevel spinal
needles to minimize the risk of post-dural puncture headache is

recommended by the ASA.

Another option the anesthesiologist has for effective pain
management in a laboring patient is patient-controlled

epidural analgesia. This may provide an effective and flexible
approach for the maintenance of labor analgesia. Patient-

controlled epidural analgesia may be preferable to fixed rate
for a continuous-infusion epidural as the patient may tolerate

reduced dosages of local anesthetics. This decision to use
patient-controlled epidural analgesia should be made on

a case-by-case basis with the consultation of the patient if

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