Guideline

Analgesia + Anesthesia for the Obstetric Patient (Guideline)

Last AANA revision: 2024

OB-specific recommendations covering labor analgesia, cesarean anesthesia, emergency C/S, and high-risk obstetric scenarios (preeclampsia, placental disorders, postpartum hemorrhage).

Key points

1.Pre-anesthesia evaluation + airway exam early in labor (Mallampati IV → 11% complication rate)
2.Aspirate every epidural top-up; test dose 1.5% lidocaine + epinephrine 15 mcg
3.Cesarean GA only when neuraxial unavailable / contraindicated — high failed-intubation rate
4.Phenylephrine first-line for spinal hypotension (better fetal pH than ephedrine)
5.Active management 3rd stage: oxytocin slow IV/IM after delivery
6.PPH protocol: oxytocin → methylergonovine → carboprost → misoprostol → TXA → surgical/IR

This is an exam-prep summary, not a substitute for the full AANA document. Read the source at aana.com for authoritative wording. Education only.