Obstetric anesthesia

The demands of patients for painless childbirth led to the widespread adoption of labor analgesia. The concept of Dämmerschlaff, or "twilight sleep", was introduced to obstetrics in the early 1900s. This new form of obstetric anesthesia was not without risk. The major fetal concerns regarding anesthesia typically involve teratogenicity and direct fetal effects. As hypertension is the most common medical disorder during pregnancy in the United States, it is among the most common problems faced in obstetric anesthesia management. Pregnancy is characterized by a progressive cardiopulmonary stress that peaks in the third trimester and dramatic hemodynamic changes occurring with labor and delivery, many of which are discussed earlier in this chapter. Obesity is emerging as an international health epidemic with approximately 1.6 billion adults currently classified as overweight or obese. Given the risk associated with general anesthesia, neuraxial techniques are overwhelmingly preferred for operative deliveries.