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Re: OB: Twin delivery/availablity of anesthesiologist--longFrom: Peter Wein (p.wein@obsgyn-mercy.unimelb.EDU.AU)Wed Dec 30 20:09:59 1998
> >What do ya'll do? Do you agree that I am justified in asking for an MD >anesthesiologist or at least an CRNA in the room? > >Garry > >-- >Garry E. Siegel, M.D., FACOG >Private Practice >Roswell, Ga. We try to have epidural in all women in labour with twins because of the eventuality you describe. Did you try a tocolytic to relax the uterus for internal podalic version/ breech extraction - GTN spray has been described as is very handy stuff to have around - stable, cheap, easy to administer, quick onset, short duration. In the old days (when I was med student - early 80's) I can remember little vials of amyl nitrite in labour ward for this, especially when there was unrecognized second twin and ergometrine had been given! We deliver twins in our delivery suite with anaesthetist just outside the room with his machine primed and ready for crash GA for 2nd twin if necessary - for vaginal delivery though - we would have to go to OR for CS. We don't have him in the room because there are enough people there already! There was a case here ( well in NSW) a few years ago where twins were being delivered with no anaesthetist on site, trouble with delivery of second twin - ended up with some neurological deficit. Decided in favour of plaintiff on basis that standard of practice (as you quote) was to have anaesthetist present. Quantum was over $1 million - quite large sum for here. Peter Wein
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