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Re: Obstetric AnaestheticFrom: Robert Brenner (robbrenner@earthlink.net)Wed Jul 24 09:59:44 1996
A > >>2. Emergency C/S: Induction with thiopenthal and succinylcholine. The >> gynecologist intends to start surgery (skin cut) before the patient is >> intubated. >> Would you let him proceed, or do you tell him to wait, until the >> patient's airway is secured? > >I have allowed Obstetricians to cut the skin incision when I could see the cords. >However, I don't really think this is such an issue. How long from decision >to induction? How long from induction to skin incision? How long from skin >incision to uterine incision? How long from uterine incision to baby out? > >Penthotal has been shown in cord blood as early as 30 seconds after injection >so I wonder what difference it really makes. I did hundreds of C/S in the big >hospital where they put the patient to sleep before they scrub and drape >and I can't say I noticed much difference. On the other hand I do become >impatient when I have the knife in the hand and the guy is telling me to wait >until he has the tube taped and all (in the other scenario scrub/drape then induce). > >In the end it's the anaesthetist's decision. Nobody can force you to allow him to cut >until you have the airway secured. What do your country's guidelines say? I would never start a C-Section under general anesthesia until the endotracheal tube is inserted. The mother's airway always takes precedence over getting the baby out. The additional time it takes to secure the airway won't make a difference to the baby in the long run.
-- Robert Brenner MD FACOG Baltimore MD Robbrenner@earthlink.net
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