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 Table of Contents  
LETTER TO THE EDITOR
Year : 2011  |  Volume : 1  |  Issue : 2  |  Page : 100-101

Association of Obstetric Anaesthesiologists guidelines for anaesthetic management of patients undergoing tubal ligation and breast feeding in the perioperative period - some comments


Department of Anaesthesia, Royal Hospital, Muscat, Sultanate of Oman

Date of Web Publication17-Mar-2012

Correspondence Address:
Athma Prasanna
Department of Anaesthesia, Royal Hospital, Muscat
Sultanate of Oman
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4472.94000

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How to cite this article:
Prasanna A. Association of Obstetric Anaesthesiologists guidelines for anaesthetic management of patients undergoing tubal ligation and breast feeding in the perioperative period - some comments. J Obstet Anaesth Crit Care 2011;1:100-1

How to cite this URL:
Prasanna A. Association of Obstetric Anaesthesiologists guidelines for anaesthetic management of patients undergoing tubal ligation and breast feeding in the perioperative period - some comments. J Obstet Anaesth Crit Care [serial online] 2011 [cited 2018 Aug 20];1:100-1. Available from: http://www.joacc.com/text.asp?2011/1/2/100/94000

Sir,

I would also like to make the following comments upon the guidelines mentioned regarding tubal ligation and breast feeding issues mentioned in the articles. [1],[2]

  1. The guidelines should be divided into preoperative, intraoperative and postoperative management guidelines. The guidelines should cover the post anesthetic care including post operative analgesia.
  2. It would be better to classify the tubal ligation as post partum and interval ligation procedures. It would be appropriate to mention the procedure as bilateral tubal ligation (BTL) instead of tubal ligation (TL) in the guidelines.
  3. The basic investigation of hemoglobin (CBC- complete blood picture) and urine analysis should be repeated/done after delivery whether the BTL is a postpartum or an interval procedure in view of hemodynamic changes during parturition, unless the antenatal hemoglobin in the third trimester is more than 10 gm %.
  4. In a guideline, it should be clear as to who provides the counseling. Is it the duty of the anesthesiologist, who during the pre anesthesia assessment checkup, declares the patient unfit for surgery or the parent team (primary physician).
  5. It would be ideal for the guidelines to mention the specific drugs to be used for the aspiration prophylaxis.
  6. Regarding the issue of intra operative monitoring with ECG, NIBP, and pulse oximetry, in my opinion these should be not only essential but also mandatory.
  7. There is some contradiction regarding aspiration risk, anxiety and aspiration prophylaxis. The guidelines should make the same clear regarding these issues which are very important and if necessary differentiate between immediate post partum tubal ligation and interval elective bilateral tubal ligation.
  8. Specific anesthetic techniques including post operative analgesia should be suggested in the guidelines regarding the conduct of anesthesia for tubal ligation by both, laparoscopic and minilaparotomy procedures.
  9. The guidelines should mention specifically the types of opioids used in the subarachnoid space along with bupivacaine and their side effects and their treatment, rather than generalizing the statement.
  10. Details of discharge criteria should be included in the guidelines than just giving the reference.


The policy that we follow regarding breast feeding in the perioperative period is as follows:

We allow the mother to feed the baby 0.5 h prior to surgery. Premedication oral midazolam is administered 1 h prior to surgery. If the surgery is feasible under regional techniques, the preferred technique would be regional. If general anesthesia is the technique, then the preferred opioid for analgesia is fentanyl and not morphine, pethidine or buprenorphine. Induction agent of choice is propofol unless contraindicated. We also administer intra muscular non steroidal anti inflammatory drugs (unless contraindicated) and 1 g intra venous paracetamol after induction of anesthesia and before incision. Balanced general anesthesia is maintained with a non depolarizing muscle relaxant, an inhalational agent which is either sevoflurane or isoflurane in oxygen - nitrous oxide mixture and IPPV. Post operative analgesia is managed by using fentanyl (severe pain) and non steroidal anti inflammatory drugs (twice daily unless contraindicated) and 1g paracetamol intravenous (twice or three times a day) for mild to moderate pain. We also use diclofenac and paracetamol as co- analgesics with fentanyl for severe pain. The mother is allowed to breast feed after 3 h of recovery from anesthesia. In case of prolonged and major surgeries, the child is fed with formula feed for 24 h or until mother is fit enough to resume breast feeding.

 
  References Top

1.Association of Obstetric Anaesthesiologists. The Association of Obstetric Anaesthesiologists guidelines for anesthetic management of patients undergoing tubal ligation. J Obstet Anaesth Crit Care 2011;1:1-2.  Back to cited text no. 1
    
2.Kundra S, Kundra S. Breast feeding in the perioperative period. JOACC 2011;1:48.  Back to cited text no. 2
    




 

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