Review Note
Last Update: 03/05/2025 03:58 AM
Current Deck: ACG Part 2::Obstetrics
New Card (Unpublished)Currently Published Content
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Commit #294880SS_OB 1.29 Discuss the management of suboptimal block including conversion to general anaesthesia for caesarean birth
Back
Commit #294880Patchy epidural:
- If no block, remove
- Repeat epidural
- Perform spinal (beware that volume in epidural space may increase height of spinal -> slight dose reduction and position head up )
- If partial/inadequate
- Withdraw epidural slightly
- Resite epidural
- If toxic limit of LA reached : Perform spinal or GA
Inadequate spinal :
- If no block, a repeat spinal may be done
- If partial but inadequate block, consider epidural insertion and slow top up
- Conversion to GA
Intra-operative inadequate block
- Inform surgeon and request the stop if possible
- Acknopwledge the patient
- Assess the stage of surgery and instigate treatment
- If skin closure LA infiltration may be reasonable
- Other options include :
- Additional epidural bolus
- Entonox
- IV analgesics : small doses fentanyl 10-20mcg, alfentanil 100mch or remi 10-20mch increments, ketamine - may cause distress with dysphoria but prefered if high risk to opioids (obsesity/OSA) 10mg increments
- Conversion GA -always offer
- Reassess - if treatment not effective reccomend GA
Oxford handbook
Waikato obstetric guidelines