Obstetrical Anesthesia

 

The Core Anesthesia Knowledge Objectives for Obstetrical Anesthesia are identified in Section VI. 2.4.  These objectives are to be obtained over the five-year residency program by completing:

   a junior (PGY 2 & 3) and senior (PGY 4 & 5) obstetrical anesthesia rotation

   the Obstetrical Core Program Lecture series and written examination

   a neonatal resuscitation provider course

   obstetrical anesthesia experience throughout the training program

   appropriate reading from the recommended text "Obstetrical Anesthesia" by Chesnut.

   preparation for the written and oral RCPSC examinations

 

 

PGY 2 & 3

 

I:    Suggested obstetrical rotation knowledge objectives for the PGY 2 & 3 rotation includes an understanding of the:

     

1.           Normal physiological changes of pregnancy.

2.           The anatomy and physiology of:

   the placenta

   common anesthetic agents on utero-placental perfusion

   pain pathways in the parturient

3.           The methods of assessing fetal well-being.

4.           Considerations for the safe use regional and general anesthesia in the parturient.

5.           Analgesia options during labour and the postpartum period (pharmacologic and non-pharmacologic).

6.           The anesthetic considerations for:

   elective and emergency cesarean sections

   preterm labour

   pregnancy induced hypertension (pre-eclampsia and eclampsia)

   multiple gestation

   abnormal fetal presentation

   common co-existing medical problems (asthma, diabetes)

7.           The management of antepartum and postpartum hemorrhage including:

   placenta previa

   abruption

   uterine atony

   retained placenta

   placenta accreta

   uterine inversion

   uterine rupture

8.           The etiology, diagnosis and management of post-dural puncture headache.

9.           The principles of neonatal resuscitation.

10.        The knowledge of commonly used local anesthetic agents in obstetrics.

 

 

II:        PGY 2 & 3 Obstetrical Skills

 

1.           Insertion of a lumbar epidural for labour analgesia.

2.           Trouble shooting common epidural problems.

3.           Performing combined spinal-epidural analgesia for labour.

4.           Administration of a spinal anesthetic for cesarean section.

 

III:       PGY 2 & 3 Obstetrical Attitudes                                   

 

1.      Effectively communicate with the patient and family the risks and benefits of an obstetrical lumbar epidural for labour analgesia using common language terminology.

2.      Develop a compassionate, reassuring and empathetic approach to the parturient and her family.

3.      Remain open to suggestions in management from nursing staff, colleagues and patients.

4.      Effectively communicate a verbal and written management plan for unanticipated problems (dural puncture, incomplete analgesia, postoperative nerve deficit etc.) with both the patient and supervising staff anesthesiologist.

5.      Demonstrate a sense of patient ownership by following patient problems to their resolution.

 

 

 

 

PGY 2 & 3 Suggested Rotation Reading Material

(Chestnut, David H.  Obstetrical Anesthesia)

 

1.      Chapter 2.         Physiologic changes of Pregnancy.

2.      Chapter 3.         Uteroplacental Blood Flow.

3.      Chapter 4.         The Placenta:  Anatomy, physiology and transfer of drugs.

4.      Chapter 6.         Antepartum Fetal Assessment and Therapy.

5.      Chapter 8.         Intrapartum Fetal Assessment and Therapy.

6.      Chapter 11.       Spinal, Epidural and Caudal Anesthesia:  Anatomy, Physiology and

                              Technique.

7.   Chapter 18.       The Pain of Childbirth and It's Effects on the Mother and Fetus.

8.   Chapter 19.       Childbirth Preparation and Non-pharmacologic Analgesia.

9.   Chapter 20.       Systemic Analgesia:  Parenteral and Inhalational Agents.

10. Chapter 21.       Epidural and Spinal Analgesia / Anesthesia.

11. Chapter 22.       Alternative Regional Anesthetic Techniques.

12. Chapter 25.       Anesthesia for Cesarean Section.

13. Chapter 26.       Anesthesia for Fetal Distress.

14. Chapter 34.       Preterm Labour and Delivery.

15. Chapter 44.       Hypertensive Disorders.

16. Chapter 35.       Abnormal Gestation and Multiple Gestation.

17. Chapter 37.       Antepartum and Postpartum Hemorrhage.

18. Chapter 27.       Postpartum Analgesia:  Systemic Techniques.

19. Chapter 28.       Postoperative Analgesia:  Epidural and Spinal Techniques.

20. Chapter 32.       Postpartum Headache.

21. Chapter 9.         Neonatal Resuscitation.

22. Chapter 51.       Respiratory Disease.

23. Chapter 41.       Endocrine Disease.

24. Chapter 12.       Local Anesthesia.