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Re: OB: Twin delivery/availablity of anesthesiologist--longFrom: R. Daniel Braun (rbraun@iupui.edu)Thu Dec 31 15:53:16 1998
At Wed, 30 Dec 1998, Garry E. Siegel, M.D. wrote: > >This past weekend, I had a 36 week vertex/vertex twin delivery >complicated by a cord prolapse of twin 2. Briefly, after the first >delivered vaginally, vertex, I ruptured #2, whose tracing had been a bit >off (variables and 165s), and in the process of vacuuming, a cord >prolapsed. Long story short, a quick attempt at a vaginal delivery >vertex didn't fly, and I could push up the head, get one foot, but I >couldn't get it down to complete an internal podalic version. Thus, I >did about as stat of a section as possible. > >Normally, I have been delivering twins under epidural, in the C/S room, >with enough nursing people/OR crew such that a section could be started >immediately. In the past, I've had the MD anesthesiologist or CRNA *in >the room*, and usually, they've had nothing to do. More recently, I've >been comfortable with one of them in the house. With this delivery, >they were in the house but not in the room, as I didn't ask the MD >anesthesiologist to be there. When the poop hit the fan, he arrived >promptly, but it took him around 3 to 5 minutes to hook up his monitors, >get his drugs, and sleep her. These 3 to 5 minutes could have been >saved had he been in the room. > >So. . . >I'm kicking myself for not insisting on their presence, and I have >little doubt that he would have been there if asked. When I discussed >this with the other MD anesthesiologists (we have 5), one of them, a >stickler for detail, studies, and cost effectiveness, wondered about >references, and the ACOG 30 minute rule. Furthermore, in our place, if >there is an after hours case, the MD anesthesiologist might be the only >guy in house, and if a section came along, he's calling in another MD or >CRNA, ie "we can start the section in 30 minutes." Obviously, if he's in >a case, and I've got twins delivering, I'm going to want a body in the >room, not just in the house. > >so. . . > >Here is what the 11/97 ACOG educational bulletin says: > >"Appropriate, experienced pediatric and anesthesia personnel should be >notified and available at delivery." > >Williams 20th edition says (page 885): > >"An experienced anesthesiologist should be immediately available in the >event that an intrauterine manipulation or cesarean delivery is >necessary." > >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. > As a medical student, 35+ years ago, I was taught that twins required the presence of 2 OB's, 2 Peds., and 1 anesthesiologist. I have not heard of any changes to this since then. Dan
--
R.Daniel Braun, MD FACOG
Clinical Professor of Obstetrics and Gynecology
Indiana University School of Medicine
Indianapolis, IN
"Heisenberg might have slept here."
Unknown or maybe Indecisive Unknown
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