[asolomio]

Hi Everyone
Im a secong year ODP and doing a presentation next week on general anaesthesia and have been given the topic of obstetric anaesthesia. Heres the question:

'Linda is 34, mother of 2 girls aged 5 and 7. Shes expecting twins and has been admitted to undergo a planned caesarean section. Lindas health is normal and her pregnancy has progressed without complication.

Her husband is a member of staff (theatre charge nurse) and wants to be there for delivery, but under GA the hospital has a policy of not allowing fathers to be present.

Her pre op baseline is BP - 140/100, Pulse - 90 bpm, Resps - 16
Urinalysis is unremarkable, only a slight trace of protein.

Linda is V anxious and tearful, never had an anaesthetic before, and husband has told her that sometimes things can go wrong or be difficult. She is worried as she is expecting twins and fears that one or both babies may suffer setbacks.'

Outline immediate care to linda in order to reassure, and subsequent anaesthetic assistance to facilitate safe surgical intervention
How would anaesthetic room be prepared.

Anyway, Im doing 1st part of the presentation which will include:
an introduction and outline if case study, talk about her past medical history and present medical state. Talk about the reasons why she may be going for a planned CS.

we are also covering: Drugs, equipment, monitoring, special baby equipment, reassurance, patient issues, anaesthetic procedure, positioning and emergency issues (failed intubation, aspiration).

Any ideas of what to put in.. or anything we may have missed out.... Ive never witnessed any obstetric anesthesia yet, may do some at some point this year so i dont know what goes on in obstetric theatres.

Catherine x

[suzanne4]

You may wish to post this in the CRNA forum, for the anesthetists take on your question.

The room would not be set up any differently, as far as the anesthesia cart or table then for any other surgery. Biggest difference in the room would be resuscitation equipment for the babies, if needed. Also, many more people around, a team for each of the babies will be there. Remember that with twins, they are usually smaller at time of delivery, the mothers usually do not go to ther planned delivery date, etc.

Most planned C-sections usually can have spinal anesthesia. If that doesn't take, or an emergency occurs with the babies, then a rapid induction would require general anesthesia. But it is not used routinely on C-sections, at least in the US.

[mwbeah]

If she has no real medical history, she wouldn't receive a general anesthetic. She would have either a spinal or epidural.

Mike

[suzanne4]

Thanks Mike for your input. That is what I have always seen......... especially for an elective C-section and not a "crash and burn."