Re: VBAC and how to fight with anesthesia...
From: art fougner, md (evsono@pipeline.com)
Wed Apr 18 22:19:51 2001
good thing no one has mentioned Peds.
art
At Wed, 18 Apr 2001, Garry Siegel wrote:
>
>With respect to Anesthesiologists/CRNAs and VBACs, I can empathize with
>Geff. It seems ludicrous at best to ask/require the MD Anesthesiologist
>to be in house, and a scrub team (if not there already)if the doc is at
>home in bed.
>
>At our smaller hospital, we compromised on an L and D policy that said
>that we would:
>1. Notify the MD Anesthesiologist of a VBAC admitted in active labor.
>We did not try to tell them how they should handle it, but they damn
>well know what is needed and why. How they respond is a blend of time
>and money, and it is there disposition to make. It wasn't a perfect
>solution, as there certainly are times when the one Anesthesia body in
>the house (an MD) is tied up in an OR case, and there is a VBAC in
>labor. We point blank told them that we would be in the house or real
>nearby, and that they (or their backup) needed to be the same. That
>said, I hope never to have a circumstance arrive in which we've notified
>them, had the scrub team in, the Ob is there, and calls a "for real"
>emergency section, and the Anesthesia person isn't so readily available.
>I don't want to be defending a case with docs blaming each other.
>2. Have the Ob "immediately available."
>3. Have nursing/scrub support for an immediate section, which may or
>may not require calling in an extra person.
>
>It is fascinating how this really occurs; I have to remind about 1/2 of
>the L and D nurses of what their protocol requires of them--notifying
>the MD Anesthesiologist, and insuring adqueate scrub coverage.
>
>Garry
>
>--
>Garry E. Siegel, M.D., F.A.C.O.G.
>Roswell, GA
>Private Practice
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
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