« Update » en Anesthésie-Analgésie Obstétricale - EIUA

Induction
Thiopental 5 – 7 mg/ kg Drug of choice
Alternative:
Propofol
Alternative:
Ketamine
2.5 mg/ kg Longer period from injection to hypnosis
Greater amnesic effect than thiopental
Risk of lower Apgar scores and hyponotus in
neonate
1 mg/ kg Alternative to thiopental for induction
Better postoperative analgesia (first 24 h)
Risk of hypertension (pre-eclampsia)
* Ketamine low dose 0.3-0.5 mg/kg Analgesic effect and potentiation of induction
agent like thiopental (↓ responsiveness for
intubation and ↓ recall)
* Remifentanil
Ultra short-acting opioid
0.5 µg/kg
then
0.2µg/kg/min
Analgesic effect (↓ responsiveness for
intubation and ↓ recall); recommended in
severe pre-eclampsia, cardiac parturients
Suxamethonium 1.5 mg/ kg Adequate dose to facilitate intubation
Very weak placental tranfert
Maintenance
Nitrous oxide > 50% Useful adjunct despite being weak anesthetic
Rapid uptake
Volatile anesthetics:
Sevoflurane, Isoflurane
at least
0.7 MAC
Rapid uptake
No problem with uterine contractility if MAC
< 0.8-1.0 (and oxytocin administration)
Opioids Usually after cord clamping!
Important placental transfert
P.Lavand’homme
Anesthesia for cesarean
section