Quick Hits in Obstetric Anesthesia

Citation

Fernando, R., Sultan, P., & Phillips, S. (Eds.). (2022). Quick Hits in Obstetric Anesthesia. Springer. https://doi.org/10.1007/978-3-030-72487-0

Chapter Summary

The book has 73 short chapters on about 490 pages, each by a different small group of contributors and most running to five to ten pages. The publisher presents it as easy-to-follow guidance for emergencies and common problems on the labor ward: "recipes" for anesthetic techniques, trouble-shooting chapters and "what to do" lists, to be used as a cognitive aid in urgent cases and a decision-making tool for urgent management plans. It is written for anesthetists of every grade. The chapters can be grouped by what they deal with.

Chapters 1–4: Labour Analgesia and Intrauterine Fetal Death

Epidurals for Labour Analgesia; Combined Spinal-Epidural Analgesia for Labour; Non-neuraxial Options for Labour Analgesia; and Management of the Woman with an Intrauterine Fetal Death (IUFD). The opening chapters cover the main ways of relieving pain in labour, with and without neuraxial techniques, before turning to a particular clinical situation.

Chapters 5–11: Anaesthesia for Caesarean Delivery

Category 4/Planned Caesarean Delivery; Spinal Anaesthesia; Combined Spinal-Epidural Anaesthesia; Epidural Top-Up; General Anaesthesia; Hypotension During Spinal Anaesthesia; and Pain Relief After Caesarean Delivery. The block of chapters is organized by technique, with separate chapters for the commonest problem (hypotension after spinal) and for analgesia afterwards.

Chapters 12–20: Procedures, Consent and Urgent Delivery

Manual Removal of Placenta; Cervical Cerclage; External Cephalic Version; Artificial Rupture of the Membranes; Consent; Documentation Standards; Umbilical Cord Prolapse; Expedited and Emergency Caesarean Delivery; and Operative Vaginal Delivery. These chapters cover minor and urgent obstetric procedures and two professional topics, consent and documentation.

Chapters 21–26: Obstetric Emergencies

Massive Obstetric Haemorrhage; Uterine Atony; Uterine Inversion; Amniotic Fluid Embolism; Vaginal Birth After Caesarean Delivery; and Shoulder Dystocia. The chapters concentrate on conditions that need rapid anesthetic participation.

Chapters 27–38: Labour Management and Obstetric Background

Normal Labour; Cardiotocography (CTG); Antenatal Care for Uncomplicated Pregnancies; Partogram; Induction of Labour; Augmentation of Labour; Pre-term Birth; Malpresentation; Placenta Praevia; Placenta Accreta Spectrum; Intrauterine Growth Restriction; and Multiple Gestation. Here the book gives the anesthetist the obstetric context: how labour is normally followed and assisted and which antenatal conditions affect anesthetic planning.

Chapters 39–49: Medical Conditions in Pregnancy

Pre-eclampsia and HELLP Syndrome; Cholestasis of Pregnancy; Gestational Diabetes; Obstetric Venous Thromboembolism; Obesity; Peri-Partum Cardiomyopathy; Complex Congenital Heart Disease and Pregnancy; Thrombophilias; Haemophilias; Von Willebrand Disease; and Low Molecular Weight Heparin, Unfractionated Heparin and Neuraxial Anaesthesia.

Chapters 50–63: Complications and Follow-up

Accidental Dural Puncture; Post Dural Puncture Headache; Epidural Blood Patch; Intrapartum Fever; Failed Epidural Analgesia During Labour; Failed Spinal Anaesthesia for Caesarean Delivery; Pain and Distress During Caesarean Delivery; Backache After Neuraxial Anesthesia; Peripheral Nerve Lesions After Neuraxial Anesthesia; Spinal Cord Lesions After Central Neuraxial Blockade; Obstetric Nerve Palsies; Reported Awareness Under General Anaesthesia; The Patient Requesting Neuraxial Anaesthesia with Previous Spinal Surgery; and Breastfeeding and Anaesthesia. These are the troubleshooting and follow-up chapters the publisher describes.

Chapters 64–73: Airway, Anaesthetic Emergencies and Resuscitation

Difficult and Failed Intubation in Obstetric Anaesthesia; Recognition and Management of High Spinal Anaesthesia; Aspiration of Gastric Contents; Local Anaesthetic Toxicity; Anaphylaxis; Malignant Hyperthermia; Maternal Resuscitation; Intrauterine Resuscitation; Neonatal Resuscitation; and Anesthetic Management of Pregnant Patients with Novel Coronavirus. The last group collects anesthetic emergencies and resuscitation of mother and baby, with a final chapter on COVID-19.

Key Concepts

Chapters 1–11: Analgesia and Anaesthesia Techniques

• Neuraxial techniques: epidural, combined spinal-epidural and spinal approaches for labour analgesia and caesarean delivery.
• Anaesthetic "recipes": stepwise approaches to each technique, in the publisher's description.
• Hypotension during spinal anaesthesia: a common complication given its own chapter.

Chapters 12–38: Obstetric Procedures, Emergencies and Context

• Urgency of caesarean delivery: planned (Category 4) versus expedited and emergency delivery.
• Obstetric haemorrhage, uterine atony, inversion and amniotic fluid embolism: the emergencies where anesthetic management is time-critical.
• Cardiotocography and partogram: the tools used to monitor fetal wellbeing and the progress of labour.

Chapters 39–73: Medical Disease, Complications and Resuscitation

• Pre-eclampsia and HELLP syndrome: hypertensive disorders of pregnancy relevant to anesthetic choice.
• Anticoagulation and neuraxial anaesthesia: the chapters on thrombophilias, haemophilia, von Willebrand disease and heparins sit next to the chapter on heparin and neuraxial anaesthesia.
• Post dural puncture headache and epidural blood patch: a known neuraxial complication and its treatment, in two consecutive chapters.
• Maternal, intrauterine and neonatal resuscitation: three separate chapters.

Critical Analysis

Strengths

• Designed for use at the point of care. The publisher frames the book as a cognitive aid for emergencies and a tool for urgent decisions, and the structure supports that: 73 narrowly titled chapters, each a few pages long.
• Broad coverage of the labor-ward workload. The chapter list runs from routine analgesia and caesarean technique to haemorrhage, airway failure, local anaesthetic toxicity and resuscitation, and also includes obstetric background chapters on labour, CTG and the partogram.
• Practical problems get their own chapters. Failed epidural, failed spinal, pain during caesarean delivery, accidental dural puncture and nerve injury each appear as separate topics, which makes the book easy to search in a hurry.
• Many contributors. The chapters are written by differing teams of authors, so no single author's practice shapes every chapter.

Limitations

• Quick-reference format, not a textbook. At roughly six to seven pages per chapter, the book cannot develop physiology or the evidence behind recommendations in depth; it should be paired with a full obstetric anesthesia text.
• Local practice differences. Titles use British terminology and the Category 4 caesarean classification, so doses, protocols and drug names should be checked against local guidelines.
• Dated or fast-moving material. The final chapter on novel coronavirus reflects the situation when it was written, and drug and guideline recommendations change; the book is not a substitute for current guidance.
• Scope. Obstetric topics are included as context for the anesthetist, not at the depth of an obstetrics text.

Where It Fits in the Course

Within the surgery and anesthesia list, this is the only book devoted to obstetric anesthesia. The other books in the list are introductions to surgery for students: Browse's Introduction to the Symptoms & Signs of Surgical Disease teaches surgical history and examination, Crash Course Surgery is a concise introduction to surgical care and common presentations, and Principles and Practice of Surgery is an undergraduate surgical textbook. Their descriptions concern surgical diagnosis and care rather than anesthetic practice, so this book serves readers who have moved from general surgical learning to anesthesia on the labor ward.

Surgical and Perioperative Management of Patients with Anatomic Anomalies is the other specialist title: it is organized by body region and deals with anatomical variation and its effect on surgical and anesthetic planning, while the present book is organized around clinical situations on the labor ward. Read the anomalies book for planning around unusual anatomy, and this one for obstetric emergencies and neuraxial technique.

How to Use This Book

The book suits anesthesia trainees starting on obstetric rotations, specialists who cover labor wards, and midwives and obstetricians who want to understand anesthetic decisions. Because it is intended for all grades of anesthetist, it can also be dipped into by readers who have completed basic anesthesia training and know neuraxial anatomy and drug pharmacology.

A practical plan: before the first labor-ward shift, read the technique chapters (1–11) and the complication chapters (50–55) so that the common tasks and problems are familiar. Then read the emergency chapters (18–26, 64–72) as a block, and practice them as scenarios with a senior colleague or in simulation. Treat the obstetric background chapters (27–38) and medical-disease chapters (39–49) as references to open when a patient presents with that condition. Use the chapter lists as a checklist for departmental teaching sessions, and always check doses and protocols against local guidelines.