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Re: Anaesthesia for emergency C-Section From: Dr Eberhard W Lisse (el@linux.lisse.na) Fri May 7 14:43:48 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Braun, R. Daniel: "FRIDAY: 100 reasons why it's great to be a guy." Previous message: Braun, R. Daniel: "Re: Anaesthesia for emergency C-Section" In reply to: Dr Suresh Deshpande: "Anaesthesia for emergency C-Section" Next in thread: Efrain Ramirez MD: "Re: Anaesthesia for emergency C-Section" Reply: Efrain Ramirez MD: "Re: Anaesthesia for emergency C-Section" Suresh, In message <19990507174837.87036.qmail@hotmail.com>, "Dr Suresh Deshpande" writes: > A primae was admitted in premature labour, with twins. Both babies > were in transverse presentation, with predicted weight around 2 > kg. The case was in small hospital, where anaesthesia coverage is > inadequate - skill and equipmentwise, and and I have to operate as > charity. Did you make any attempts at suppressing her labour and how successful was this? Did you give steroids? > The anaesthetist said, under the circumstances, he has to go for > spinal anaesthesia. I was expecting difficult extraction, but > general anaesthesia was not possible. I don't understand this. You have an anaesthetist, but he can't give anaesthetics? > The first baby was having the convexity of spine as presenting part. What skin incision did you do, and what uterine incision? > It took me three minute to vatch the ankle. Completion of delivery > took mearly two more minutes. Did you extend your incision? > I could rupture the membranes of second baby, immediately. And this > one was also presenting by its spine. I hoped that the increase of > available space will make this delivery easier, but no. It became > virtually ipossible to insinuate my fingers upto the foot. There > was no part of this baby that could be grasped with a forceps. > At the end of about 12 minutes, I managed to deliver this baby. 12 minutes after incision into the Uterus or after extraction of the first baby? > The Apgars were 6 & 9 for the first and 0 & 5 for the second. The > weights were 2.1 and 1.9 kg. The second baby was required to be kept > in intensive care, and died due to Respiratory Distress Syndrome > after 5 days. How was the baby rescuscitated and by whom? > The spinal anaesthesia is known to cause intense contraction of > uterus. This effect is observed after about 8 to 12 minutes of > administration. Well, I haven't operated many under spinal, but that's the first I hear about it. > If you think that you may not be able to deliver baby/babies by this > time, it is better to plan for general anaesthesia. I can't follow your timing, though. After the Spinal it takes at least 10 minutes to get her scrubbed and draped. So you are in fact saying that no spinals should undertaken for C/S? > I was forced to operate under the specified circumstances, and lost > a baby. All comments are welcome. I don't think you can blame it on the anaesthetist, though I think he should be hauled in front of the Medical Board (if such a thing exists in your country) for not being able to give a General Anaesthetics. I would have tried to tocolyse her in the first place and give her steroids. If delivery was unevitable I would have (and have done in transverse and compound presentations) a midline skin incision and either a low Classical or a skewed transverse ("J") incision, that you can extend easily. After a minute of trying I would have (and have in similar cases) extended the incision as much as required, no matter how large and what happened to the Uterus afterwards. 12 Minutes post uterine incision is not justifiable in my view. I am really quite interested in the rescuscitation aspect. el Next message: Braun, R. Daniel: "FRIDAY: 100 reasons why it's great to be a guy." Previous message: Braun, R. Daniel: "Re: Anaesthesia for emergency C-Section" In reply to: Dr Suresh Deshpande: "Anaesthesia for emergency C-Section" Next in thread: Efrain Ramirez MD: "Re: Anaesthesia for emergency C-Section" Reply: Efrain Ramirez MD: "Re: Anaesthesia for emergency C-Section"

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