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Re: Anesthesia for Emergency CesareanFrom: Jane Helwig, MD (jane@seasonedsystems.com)Tue Mar 23 08:54:17 1999
At Mon, 22 Mar 1999, Ronald E. Ainsworth wrote: > >Is there any consensus on what is the safest anesthesia for a cesarean >section when a truly emergent need arises and no room or >anesthesiologist is readily available? It has been suggested that a cesarean section in a L&D >room under local infiltration would be the safest option. Recently I had a prolapsed cord, heart rate in the 60s which did not improve with elevating the head or knee-chest position. Could not replace the cord. Not even an IV in the patient. No in-house anesthesia. Since we often don't have in-house anesthesia, I had thought a lot about this possibility and had decided that the safest place for emergency c/s under local was in the OR. I also frequently review the guidelines for emergency c/s under local that I was taught by the late great Dr. Gil Webb in San Francisco. All the preparation in the world, though, isn't enough when the scenario actually happens. With the patient on the labor bed, we flew downstairs to the other end of the hospital where the ORs are. A nurse started an IV. I injected the 0.5% lidocaine as described by Dr. Webb and my experience mirrors Dan's--the patient was not happy. However, I got the baby out within 10 minutes. Initial Apgars were low and there was some cerebral edema which resolved and now everything seems to be OK. Not an experience I ever want to relive. I felt that the OR was the best place to be because as OR crew arrived, especially anesthesia, they could begin helping. I did not want to jeopardize her life by doing surgery in a labor room. Like Dan, I waited until anesthesia got there to remove the placenta and close. My patient (a nurse, of course!) vocally resisted general anesthesia so we finished the case with IV sedation. In the book "Intern" by Dr. X, there is a description of an obstetrician doing a vaginal exam on a patient with unsuspected placenta previa and putting his finger into the placenta. As the blood starts pouring out of the vagina, he says, "Get me a knife," and does a bedside emergency c/s. It didn't sound like he bothered with local anesthetic.
-- Jane Helwig, MD Private practice Nassawadox, VA
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