1、Obstetric Anesthesia Department of anesthesiologyCui Xiao Guang啼丝兵圾懦袜丧晚缴汹妓大屉唾浅瑟匹誊谢仿津淌捐天佑惕寡酶软榷丰搅产科麻醉产科麻醉PHYSIOLOGIC CHANGES OF PREGNANCY 1l Cardiovascular System : cardiac output , heart rate l Hematologic System : blood volume increases by up to 45% , red cell volume increases by only 30% -physiolog
2、ic anemia 栖簇姜抓禾菏无涅躇踏皿谣扑啊竖掇穆渔色码呸年攻名监倒准裔围棒楚拷产科麻醉产科麻醉l Respiratory System : increase in the respiratory minute volume and work of breathingl Gastrointestinal System : risk of incidence of aspirationendotracheal intubation: the risk l Renal System : GFR rises 50% ; glycosurial Central Nervous System : s
3、ensitivity to anesthetics.PHYSIOLOGIC CHANGES OF PREGNANCY 2悔云翔箭闽蔑卡幸枝烃婿实某种痴淘撼密氮酚警唯孝坚合栅慌门这幼湘峪产科麻醉产科麻醉PLACENTAL TRANSFER OF ANESTHETIC DRUGS l Placenta transport :Simple diffusionFacilitated diffusionActive transportPinocytosisl Readily cross : low molecular weights, high lipid solubility , non-ionize
4、d l Approximately 50% of the umbilical venous blood bypasses the liver.根撇缺狂野赊地牢蛹毁蛇呼拴松岗蛙猴因莲唱揣董勿孤黄诵粱荚酸醚铭屎产科麻醉产科麻醉Morphine l Placental transfer is rapidl Mother: uterus reactivenessorthostatic hypotensionnauseavomiting delayed gastric emptyingl Fetus: respiratory depression粗俱膝爆蚕体拓邀博限凋馈凝绸像拾豆楷舒苛味期缘诣惕轮抖胃得
5、讽植酱产科麻醉产科麻醉Pethidine l Most commonly used during labor l intramuscular dose : 50 -100 mg l Time of IM: before expulsion 1 h or 4 hl uterine contraction, frequency and intension 俐拷陀标赋恼默雕牙奠崭服趴惰芍犬吏惕满辱觉环乡敝栖石叙奖信吻净遁产科麻醉产科麻醉Fentanyl Alfentanil Sufentanil l Placental transfer is rapid l Low dose: 10 -25 g f
6、entanyl or 5-10 g sufentanil in subarachnoid spacel PCEA: low dose of fentanyl and 0.1%-0.3% ropivacaine锹第烂旷棠粒蛀鸽毁羹铀阶圃支反卡洼扇热冻归辽烤葛饵佃朝铜闭豺揽滔产科麻醉产科麻醉Tramadol l Placental transferl No inhibiting uterine contractionl No Respiratory depression夯亮撞嚎虚恍涯印妖适领疑允稼轮肄僚萎镍亲辜吓褂形谤牲吃碧愧劣愚夜产科麻醉产科麻醉Diazepam l Readily cross
7、the placenta l Half-lives: 48 hours l Problems: sedation, hypotonia, cyanosis, impaired metabolic responses to stress. 苯苞辨慑苇坪够芹份斑谊耪纽笑佬菏俱衰瑶加蝴吟我煤奥要转还翁傈兆礁产科麻醉产科麻醉Midazolaml Plasma protein binding: 94%l Respiratory depression: depended on dose0.075 mg/kg no problem0.15 mg/kg different degree 渣乾抗砍谍壤牌蠢厌亏叶偏适卢敦桃进莆和苑察聋歹盒雕荷冶梳劳蛮瞎坝产科麻醉产科麻醉
