12 - Obstetric anaesthesia

Summary

Key learning points

The approach of this chapter is to be ‘about’ obstetric anaesthesia rather than a commentary on anaesthetic techniques. The intention is to provide the anaesthetic practitioner (AP) with a suitable level of knowledge to support practice by enabling a link to related surgical procedures, patient conditions, altered anatomy and physiology and adjusted biochemistry that creates the potentially hazardous situations unique to this speciality. In tandem with this will be the incorporation of the contribution of the AP and how their role and responsibilities impact upon procedures and outcomes.

• Altered anatomy, physiology and biochemistry

• Related conditions

• Treatment modalities

• Surgical interventions

• Anaesthetic techniques

• Scope of practice

Introduction

Obstetric anaesthesia is now recognised as an anaesthetic sub-speciality and acceptance is confirmed by the establishment in the UK of the Obstetric Anaesthetists Association (OAA). This acceptance as a stand-alone speciality is due in part to the inherent risk factors and potential hazards presented by the obstetric patient combined with the objective to establish a consistent anaesthetic approach to the speciality. Accordingly, the position of the attending anaesthetic practitioner (AP) becomes one of specialist, suitably knowledgeable and armed with an understanding of anaesthetic needs and interventions required in this particular setting.

When discussing obstetric anaesthesia there is an inclination to limit discussion to caesarean section (C/S) or consider it as the benchmark. Nevertheless, related procedures such as evacuation of retained products of conception (ERPC) at the minor end of the scale and placental abruption at the other, warrant equal attention while procedures such as ectopic pregnancy should be included as they are by nature, obstetric orientated, in spite of the latter often being viewed as a general gynaecology emergency.