OB-GYN-L Messages for October, 2007: Re: Total Spinal

Re: Total Spinal

From: ainsron

ainsron@sbcglobal.net

Fri Oct 26 13:35:25 2007

Ronald E. Ainsworth, MD, FACOG

-----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Frances Wren Sent: Friday, October 26, 2007 11:24 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Total Spinal

if near enough delivery you..ie the anaesthetist...could just bag the patient..while you reassure..tip her feet down in hope won't keep rising..the epidural/spinal that is ...and as long as babe OK deliver normally... probably best in a multip if this "misfortune" happensas thast will be quicker delivery usually. I had this happen to me ages ago when i did a caudal on a very shoert lady...I whammed the stuff in...then had to explain to her as she was having

difficulty breathing and i was calling anaesthesia(who bagged her)..that "this sometimes happens"..(it never had to me before , nor again thank goodness)...but she did fine..primip..and we shortly got a normal delivery.(I did use forceps) babies heart needless to say dropped..but with O2 and bagging rose back to normal pattern....till delivery. admit I never did a caudal again...and now anaesthesia does all these paralysing things..not I. frances wren MD FRCS.

>----- Original Message -----
From: "Dr. Ainsworth" <ainsron@sbcglobal.net> To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net> Sent: Friday, October 26, 2007 9:42 AM Subject: Total Spinal

> The CNMs who I backup had a patient who was making very slow progress in
> labor, 42 week, G4 P3003, brought in for induction, had a LEEP following
> her last pregnancy. They were concerned about cervical stenosis and I
> agreed - she was 2cm with a very tight, band-like cervix. We had an
> epidural placed by anesthesia, it was a difficult placement, she was
> rocking and rolling. He didn't identify any problems with the test
> dose, but the full dose resulted in a T-2 level that continued to rise,
> she developed muscle weakness in her arms and developed dyspnea, O2 sats
> began to drop. Baby did well through all of this, her BP did drop and
> she required a dose of ephedrine to stabilize the BPs. Anesthesia was
> concerned that he would have to intubate her soon and requested that we
> go to the OR for immediate delivery. I did the C/S and baby did fine.
> Mom did have to be intubated in the OR and PACU for about 45 minutes
> after the procedure. In this patient I felt there were definite ob
> indications for the C/S: failed induction, cervical stenosis, in
> addition to the anesthesia related indication for immediate delivery.
>
> How would you manage a total spinal in a "normally laboring" patient who
> does not have anything going on obstetrically? Is C/S still the best
> course in all cases, or would it be best to simply have anesthesia
> ventilate the patient until the spinal/epidural wears off and then
> manage the labor accordingly? The anesthesiologists concerns and worries
> relate to lack of all the normal equipment he needs in the L&D suite,
> and I can understand reluctance on his part to intubate there, except
> for very acute emergencies - and then move the patient to a location
> where he has a ventilator, etc., i.e to the OR suite.
>
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