Re: Anaesthesia for emergency C-Section
From: Efrain Ramirez MD (eramirez@icepr.com)
Sat May 8 10:32:31 1999
Ummm... not much to add or say after what Eb said.!
At Fri, 07 May 1999, Dr Eberhard W Lisse wrote:
>
>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
--
Efrain Ramirez MD FACOG
"The things you learn after you know everything are the important ones"
