The most signiicant factor linked to lower maternal mortality rates is the greater use of regional analgesia (Hawkins, 2011). In-house anesthesia coverage that is available around the clock is certainly another contributing factor. Logically, with increased use of regional analgesia, there are now reports of complications with these techniques. Indeed, compared to pre-1990 data, post-1990 obstetrical anesthesia was associated with more legal claims involving regional analgesia (Davies, 2009). In a recent analysis of 466,442 obstetrical hospital discharges, complications associated with regional analgesia accounted for 81 percent of anesthesia-related adverse events (Guglielminotti, 2015).
For the fetus, recent human studies suggest that single, relatively short exposure to general anesthetic and sedation is unlikely to have negative efects on subsequent behavior or learning. his evidence is presented in Chapter 46 (p. 901). That said, in 2016, the Food and Drug Administration (FDA) warned that repeated or lengthy use of general anesthetic and sedation drugs in pregnant women during their third trimester may afect fetal brain development. Listed drugs include inhalation agents used in general anesthesia as well as lorazepam, ketamine, propofol, and midazolam. Notably, the American College of Obstetricians and Gynecologists (2016a) and the Society for Obstetric Anesthesia and Perinatology (2017) have voiced concerns with this statement and cited the lack of signiicant human data, especially in pregnant women, to underpin this warning.
he American College of Obstetricians and Gynecologists (2017a) recognizes that a woman's request for labor pain relief is suicient medical indication for its provision. Identification of any of the risk factors shown in Table 25-2 should prompt consultation with anesthesia personnel to permit a joint management plan. This plan should include strategies to minimize the need for emergency anesthesia.
Goals for optimizing obstetrical anesthesia services have been established by the American College of Obstetricians and Gynecologists (2017 a) and the American Society of Anesthesiologists (2016) and include:
TABLE 25-2. Maternal Factors That May Prompt Anesthetic Consultation
Obstructive lesions: edema, anatomical abnormalities, trauma Decreased range of motion in opening the mouth or small
Obstetrical complications with a high risk of operative delivery
Matenal medical complications such as cardiopulmon 1.
Availability of a licensed practitioner who is credentiled to administer n appropriate anesthetic whenever necessary and to maintain support of vital unctions in an obstetrical emergency.
2.
Availability of anesthesia personnel to permit the start of a cesarean delivery within 30 minutes of the decision to perform the procedure.
3.
Anesthesia personnel immediately available to perform an emergency cesarean delivery during the active labor of a woman attempting vaginal birth ater cesarean (Chap. 31, p. 597).
4.
Appointment of a qualified anesthesiologist to be responsible for all anesthetics administered.
5.
Availability of a qualified physician with obstetrical privileges to perform operative vaginal or cesarean delivery during administration of anesthesia.
6.
Availability of equipment, facilities, and support personnel equal to that provided in any surgical suite.
7.
Immediate availability of personnel, other than the surgical team, to assume responsibility for resuscitation of a depressed newborn (Chap. 32, p. 606).