Guidelines for obstetric anesthesia revised

Recognizing that each patient's labor and delivery experience is unique, the American Society of Anesthesiologists (ASA) Practice Guidelines for Obstetric Anesthesia were recently revised to enhance the quality of anesthetic care for obstetric patients, improve patient safety by reducing the incidence and severity of anesthesia-related complications, and increase patient satisfaction.

The revised Practice Guidelines for Obstetric Anesthesia, featured in the April issue of the journal Anesthesiology, focus on the latest evidence-based recommendations for anesthetic management of women during labor, through operative and nonoperative delivery, postpartum care and pain control. The guidelines also provide key information for patients to be aware of before receiving anesthetics during labor.

“Not all women require anesthetic care during labor and delivery,” said Joy L. Hawkins, M.D., chair, ASA Task Force on Practice Guidelines for Obstetric Anesthesia. “If a patient does request pain relief during labor and delivery, there are many analgesic (pain relief) techniques available. The options will depend on the patient's medical status, the progress of labor and the resources available at the treating facility.”

Key recommendations addressed by the ASA Task Force on Practice Guidelines for Obstetric Anesthesia in the revised guidelines include:

• Obstetric patients should receive the same standard of care as patients in the main operating room. Patients should discuss their medical history with their anesthesiologist and should receive a physical examination of the airway, heart and lungs prior to anesthesia being given.
• The equipment, facilities and support personnel for the labor and delivery operating suite should be comparable to the resources available in the main operating suite.
• Drinking clear liquids in limited quantities has been found to bring comfort to laboring patients and does not increase labor complications. Patients with uncomplicated labor may drink small amounts of clear liquid, while patients scheduled to undergo a nonemergency cesarean section may drink small amounts of clear liquids up to two hours before receiving anesthesia.
• Solid foods should be avoided by patients during labor. Patients scheduled for elective surgery such as cesarean section or tubal ligation should fast for a period of six to eight hours prior to anesthesia being given.
• Patients in early labor should be offered the option of receiving neuraxial analgesia (spinal or epidural) when the service is available, and it should not be withheld to meet arbitrary standards for cervical dilation. Patients can be reassured that receiving neuraxial analgesia or pain blocks, including epidural analgesia and spinal analgesia, does not increase the incidence of cesarean section.
• The use of spinals or epidurals is preferred over general anesthesia for most cesarean sections.
• To minimize the frequency of post dural (spinal) headaches, pencil-point spinal needles should be used instead of cutting-bevel spinal needles for spinal anesthesia administration.

Dr. Hawkins added, “The revised practice guidelines do not guarantee specific outcomes, but provide basic recommendations based on a synthesis of expert research and recommendations.”

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