Emergency C/S with local anesthetic only - page 2

Well, I think I've come up with a topic not seen here before. We recently had a woman come in via ambulance with a cord prolapse & the paramedics tried hard to do their best by keeping a hand in the... Read More

  1. by   canoehead
    Sheesh, if she was already dilated 8cm the smart money says her pelvis is more than adequate. Surely less risk to deliver than to do a local CS.

    As far as local anesthetic for a CS, why aren't they doing general with rapid induction and then diving in for the baby ASAP. I've been present for several deliveries with general, and so long as the doc is quick baby has been just fine. Surely it's a better option than the stress and catecholamines released during a surgery without adequate pain control.
  2. by   imenid37
    Quote from canoehead
    Sheesh, if she was already dilated 8cm the smart money says her pelvis is more than adequate. Surely less risk to deliver than to do a local CS.
    I thought that too. We don't have 24 hr. anesthesia. They would do local for severe unstable hemmorhage or prolapsed cord, etc. but not for breech if all seemed to be going okay. We would take pt. to OR and have everything ready to start as well as stuff for breech vag delivery.
  3. by   mitchsmom
    Quote from canoehead
    As far as local anesthetic for a CS, why aren't they doing general with rapid induction and then diving in for the baby ASAP. I've been present for several deliveries with general, and so long as the doc is quick baby has been just fine. Surely it's a better option than the stress and catecholamines released during a surgery without adequate pain control.
    No in-house anesthesia after hours and on weekends or we would be happy to do quick general.
    We do use general for emergent c/s when anesthesia is present, or if regional doesn't work.
  4. by   LizzyL&DRN
    Quote from 33-weeker
    I can't imagine even THINKING about doing this for a simple breech - esp. for a mom with a previous successful vag. delivery. Up until the not too distant past, 80% of breeches were delivered vaginally - most successfully.
    I KNOW!!! I just about fell over when she said it! I thought going into the OR, i'd finally get to see a breech delivery, not a CS under local only. Thank God it didn't happen.
  5. by   CEG
    Quote from LizzyL&DRN
    The mom came in after laboring at home for several hours(don't know why she waited) at 8cm. ?
    She probably waited because she didn't want a c-section. Most people believe that if they show up far enough along the doc will go ahead and deliver. I can't imagine how traumatic a c-section under local would be to someone with those hopes. Seems a little out of control to me.
  6. by   Gem97
    Have seen this done 3 times, same doc in the last two years on the unit I work for. All three cases, the baby survived, although full resuscitation was needed. Lidocaine was typically injected into the first layer, the pt's screaming would resonate in my ears after my shift was through. All three cases, anesthesia was coming from their house, and no sedatives were given to the pt once the infants were delivered. Glad we don't experience this any more than we need to.
  7. by   babynurselsa
    Quote from jemommy
    I am still in nursing school and I have a question. Why is this procedure so risky for the babies? What is the difference (to the baby) whether or not the mom has the proper anesthesia? Does local anesthesia slow the heart rate, whereas general or epidural won't? just curious.
    It is not the anesthesia or lack that is risky to the baby. THis is an infant is serious distress that need out NOW. This baby is so compromised at this point that every second counts. We are essentially talking about a code situation for the baby. Unfortuanately you have to get the baby out of mom to respond. This is why you see that there are such sad outcomes sometimes.
  8. by   klone
    We've had to do it twice in the past year.
  9. by   dijaqrn
    I can remember the battle to try to save my vaginally delivered, meconium stained daughter as if it was yesterday. I'd have had a section with no local if it would have saved her. I think those docs are pretty brave trying to save these infants in this day and age. Good luck to them and God Bless those Moms and babies.
  10. by   mugwump
    I understand why. I agree why. But I still say barbaric. Granted I work in a level three hospital where we ALWAYS have a doc we ALWAYS have anethsesia and we ALWAYS have a CRNA who after the patient has a spinal in the CRNA pretty much takes over leaving the anethesiologist free to do epidurals or a true crash that runs through the door.

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