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Re: Anaesthesia for emergency C-Section From: Paul Prior MD (pprior@earthlink.net) Sun May 9 21:10:33 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DoctorJoe@aol.com: "FRI: HMO's and God" Previous message: James Connerth: "Re: OB/GYN Survey" In reply to: Dr Suresh Deshpande: "Anaesthesia for emergency C-Section" Next in thread: Dr Eberhard W Lisse: "Re: Anaesthesia for emergency C-Section" Reply: Dr Eberhard W Lisse: "Re: Anaesthesia for emergency C-Section" On Fri, 7 May 1999 12:49:31 -0500, you wrote: >The anaesthetist said, under the circumstances, he has to go for spinal >anaesthesia. I was expecting difficult extraction, but general anaesthesia >was not possible. The first baby was having the convexity of spine as >presenting part. It took me three minute to vatch the ankle. Completion of >delivery took mearly two more minutes. I could rupture the membranes of Back down transverse lie is an indication for classical incision of the uterus. >The spinal anaesthesia is known to cause intense contraction of uterus. This I'm not aware, not have I seen this effect of spinal. Upon what do you base this claim? >effect is observed after about 8 to 12 minutes of administration. 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 was forced to operate under the >specified circumstances, and lost a baby. >All comments are welcome. I feel you were placed in a difficult circumstance in that if you want general anesthesia you should be able to get it and any anesthesiologist who can't provide it shouldn't be practicing OB anesthesia! However, a couple things may have made this a bit easier, 1) consideration of a classical incision as mentioned above, and 2) use of tocolytics during the extraction to try to maximize your working space. IV terbutaline works quickly (onset 30-60 secs) and fades fast (generally 3-5 mins it is mostly gone) and is always in the back of my mind for these circumstances. The other comment I would make is that if you find yourself struggling with a delivery (especially a back down transverse lie) and you've already made a low segment transverse incision, don't be afraid to "T" the incision - again has saved my behind more than once.... My sympathies for this difficult case. Operating under less than ideal circumstances always adds significant difficulty to an obviously difficult beginning. -- Paul Prior MD pprior@earthlink.net Don't Blame Me... Ashland, KY USA I Voted For Bob Dole "No question that an admission of making false statements to government officials is an impeachable offense" Bill Clinton, 1974 Next message: DoctorJoe@aol.com: "FRI: HMO's and God" Previous message: James Connerth: "Re: OB/GYN Survey" In reply to: Dr Suresh Deshpande: "Anaesthesia for emergency C-Section" Next in thread: Dr Eberhard W Lisse: "Re: Anaesthesia for emergency C-Section" Reply: Dr Eberhard W Lisse: "Re: Anaesthesia for emergency C-Section"

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