{"id":1755,"date":"2010-12-14T07:29:57","date_gmt":"2010-12-14T07:29:57","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/infiltration-anaesthetic\/"},"modified":"2023-09-20T09:58:48","modified_gmt":"2023-09-20T08:58:48","slug":"infiltration-anaesthetic","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/obstetrics\/management-of-childbirth\/infiltration-anaesthetic\/","title":{"rendered":"Infiltration Anaesthetic"},"content":{"rendered":"<hr \/>\n<h3><span style=\"text-decoration: underline;\"><span style=\"color: #003366;\"><strong>Administration Of Infiltration Anaesthetic Into The Perineum<\/strong><\/span><\/span><\/h3>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">Decide where the episiotomy will be made. If the care provider is standing to the right of the woman, a <span style=\"color: #33cccc;\"><strong>mediolateral episiotomy<\/strong><\/span> will usually be made from the middle of the posterior commissure, in the direction of the left ischial tuberosity (<em>from the median line with an angle of about 45\u00b0 past the anus<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Put on the <span style=\"color: #33cccc;\"><strong>sterile gloves<\/strong><\/span>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Draw <span style=\"color: #33cccc;\"><strong>10-20 ml local anaesthetic<\/strong><\/span> into a syringe; place a long needle on the syringe.<\/span><\/li>\n<li><span style=\"color: #003366;\">Place two fingers between the <span style=\"color: #33cccc;\"><strong>head of the foetus<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>posterior commissure<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>stretch the perineum<\/strong><\/span>.<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Disinfect<\/strong><\/span> the injection and episiotomy site with a gauze soaked in a 1% chlorhexidine solution or a 10% povidone-iodine (<em>Betadine\u00ae<\/em>) solution.<\/span><\/li>\n<li><span style=\"color: #003366;\">Insert the needle into the perineum as close as possible under the skin via the posterior commissure. The needle should follow the route of the planned episiotomy.<\/span><\/li>\n<li><span style=\"color: #003366;\">Check that the point of the needle has not inadvertently entered a blood vessel by aspirating the hypodermic syringe slightly; if it is located intravascularly, withdraw the needle a little and check again.<\/span><\/li>\n<li><span style=\"color: #003366;\">As the needle is gradually drawn back, inject half the anaesthetic under the skin.<\/span><\/li>\n<li><span style=\"color: #003366;\">Repeat this procedure several times in a fan-shaped direction around the point of insertion in the posterior commissure.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\">Local anaesthetics are potentially dangerous substances. The therapeutic spectrum, the range between effective and toxic concentration, is fairly narrow. If a practitioner is unaware that an anaesthetic requires 3 to 5 minutes before it takes effect, they may inject increasingly more anaesthetic, which may lead to <strong><span style=\"color: #33cccc;\">toxic<\/span> <span style=\"color: #33cccc;\">concentrations<\/span><\/strong> of the anaesthetic. Overdose symptoms are dependent on the rate at which the concentration of the anaesthetic rises in the blood. The following symptoms can occur due to resorption from the tissues:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Anxiety.<\/span><\/li>\n<li><span style=\"color: #003366;\">Transpiration.<\/span><\/li>\n<li><span style=\"color: #003366;\">Confusion.<\/span><\/li>\n<li><span style=\"color: #003366;\">Numb feeling in tongue and lips.<\/span><\/li>\n<li><span style=\"color: #003366;\">Impaired speech.<\/span><\/li>\n<li><span style=\"color: #003366;\">Visual and auditory disorders.<\/span><\/li>\n<li><span style=\"color: #003366;\">Twitching in the face.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\">If the medication accidentally enters a vein directly then the following symptoms can occur:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Tremors.<\/span><\/li>\n<li><span style=\"color: #003366;\">Muscle cramps.<\/span><\/li>\n<li><span style=\"color: #003366;\">Convulsions.<\/span><\/li>\n<li><span style=\"color: #003366;\">Apnoea.<\/span><\/li>\n<li><span style=\"color: #003366;\">Cardiac arrest.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\">These symptoms arise from the effects of the drug. The anaesthetic numbs the nerve and in this manner, deregulates the organ systems in which the nerve impulse is involved (<em>cardiovascular, CNS<\/em>).<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">Management in case of signs of overdose:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Stop infiltration.<\/span><\/li>\n<li><span style=\"color: #003366;\">Keep talking to the woman.<\/span><\/li>\n<li><span style=\"color: #003366;\">In the event of a home birth, call for an ambulance immediately.<\/span><\/li>\n<li><span style=\"color: #003366;\">If necessary, administer oxygen and insert an oropharyngeal airway (<em>Mayo tube<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">If necessary, administer diazepam, ephedrine or atropine.<\/span><\/li>\n<li><span style=\"color: #003366;\">If necessary, reanimate.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Administration Of Infiltration Anaesthetic Into The Perineum Procedure Decide where the episiotomy will be made. If the care provider is standing to the right of the woman, a mediolateral episiotomy will usually be made from the middle of the posterior commissure, in the direction of the left ischial tuberosity (from the median line with an [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[58],"tags":[138],"class_list":["post-1755","post","type-post","status-publish","format-standard","hentry","category-management-of-childbirth","tag-obstetrics"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Infiltration Anaesthetic - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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