Review Note
Last Update: 03/05/2025 03:35 AM
Current Deck: ACG Part 2::Obstetrics
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Front
Commit #294870
SS_OB 1.28 Discuss the management of significant complications of neuraxial analgesia and anaesthesia in childbirth, for example:
- total spinal
- total spinal
Back
Commit #294870- Commonest cause of maternal cardiac arrest in UK delivery suites
- Usually presents immediately but may be delayed (positional changes, subdural catheter)
- Spinals in presence of partial epidural block at higher risk
- If the block is rising rapidly:
- If hyperbaric solution, position patient head up and observe closely
- If plain LA: position in left lateral position to minimise dural compression through vein engorgement and observe closely
- No sudden movements (may cause further spread)
- Equipment:
- Ventilatory and CVS support should be immediately available
- Look for:
- Respiratory paralysis
- CVS depression
- Unconsciousness
- Fixed, dilated pupils
- Call for help
- ABC approach, may need intubation even if still conscious (used reduced doses)
- Maternal and fetal monitoring, delivery of fetus if signs of fetal distress
- Ventilation usually needed for 1-2hrs until block wears off
- Extubate awake, good handgrip strength etc