They did a c-section without anesthesia

imenid37 · Dec 4, 2006

I work at a place probably similar to Deb and Steph. The anesthesia coverage is 24/7, but not in house. They have 30 min. from decision to incision. We almost never fail to meet it for a stat. I can't remember any cases in the last 10 yrs. where we didn't. I think in certain cases, like a blizzard, that anesthesia should have to stay onsite. I had a doc come in to place an epidural a couple of years ago during a snow storm and then leave. To me, that is not acceptable. He said if a stat was needed, Ob could call himand then he could tell her how to "dose it up." Yeah, right. BTW 4/5 of our ob's are DO's and they are really good doctors. We have a drill to practice how we would prep pt. for stat C/S and we have a local anesthesia box at the ready.

Mrs.S · Dec 4, 2006

We also have 24/7 anesthesia coverage but not in house. Decision to incision on a stat section is 30 min here also, but seriously, 30 minutes and oftentimes you could be looking at a dead baby. They had this baby out in 15 minutes and he is doing well in NICU. Usually anesthesia is VERY prompt, I have never seen them take 20 minutes to get there like what happened the other night. The anesthesiologist that was on is newer, at least to this hospital, and I don't know how that factors into it.

What bothers me is that she didn't try to even use local. Maybe like someone said, she just panicked. But after baby was out the RN's that were in our OR that night asked her several times to wait for anesthesia before finishing the case, and she ignored them. We're wondering why she could not have packed the pt and waited the five more minutes it took for anesthesia to come in. or explained to us why she couldn't.

The 18-year-old primip mom is doing fine, I don't even really think she realizes what happened. Obviously we are getting our manager involved and asking that some of our policies be looked at. I'm just wondering what our other responsibilities are, and if any of you have seen a similar case what happened afterwards.

Marie_LPN, RN, LPN, RN · Dec 5, 2006

Our MDA on-call sleeps in one of the docs' call rooms. We always have one in houose all the time.

jrussole · Dec 5, 2006

Anesthsia isn't used normally during C-section. Only if the epidural doesn't work and the patient continues to experience pain. At least in our facility. The patient even walks into the OR, receives a dose of pain medication thru her epidural line or the epidural line is inserted at that time. Most of the time, mothers want to be awake during the birth of the baby. Therefore, anesthsia is not the option of choice during c-section delivery. A local is not used in this event. It is not necessary, except for the implantation of the epidural catheter.

jrussole · Dec 5, 2006

If the anethesiologist is not available- we wait until one is. Never has an MD delivered a baby in our facility that I know of without them. It increases the OB MD's responsibility if something occurs. Most MD's aren't going to risk delivering a baby in such as manner. Sounds pretty horrific. If anything, a dose of Fentanyl and Morphine might due to trick.

allnurses Guide · Dec 5, 2006

Anesthsia isn't used normally during C-section. Only if the epidural doesn't work and the patient continues to experience pain. At least in our facility. The patient even walks into the OR, receives a dose of pain medication thru her epidural line or the epidural line is inserted at that time. Most of the time, mothers want to be awake during the birth of the baby. Therefore, anesthsia is not the option of choice during c-section delivery. A local is not used in this event. It is not necessary, except for the implantation of the epidural catheter.

Just for clarification, an epidural is considered "anesthesia".

And our physicians re-dose the epidurals at times. We don't do "walking epidurals".

We have a CRNA - not a anesthesiologist. And he is good.

steph

dawngloves, BSN, RN · Dec 5, 2006

Anesthsia isn't used normally during C-section. Only if the epidural doesn't work and the patient continues to experience pain. At least in our facility. The patient even walks into the OR, receives a dose of pain medication thru her epidural line or the epidural line is inserted at that time. Most of the time, mothers want to be awake during the birth of the baby. Therefore, anesthsia is not the option of choice during c-section delivery. A local is not used in this event. It is not necessary, except for the implantation of the epidural catheter.

Yes but the OP isn't talking about a normal c/s. I've been to many a stat c/s for fetal bradycardia that have taken 3 minutes from the the minute they hit the OR to the baby being out. These are cases where I've been handed a purple baby. 99% of the time the outcome is good.But you have to think, if it had taken 20 minutes for someone to come and put this woman under general......:uhoh21:

jrussole · Dec 5, 2006

I don't think we have received the whole picture of the incident. Because if she wasn't given a local, wasn't given pain medication in any manner, than it would be a reportable incident.

mom23RN · Dec 5, 2006

Boy, in this case it sounds like surgery without anestesia = live baby.

Wait for anesthesiologist to get there = dead baby.

I think almost any mother you talk to (even if the delivery/c-sect was horrible and you felt everything) would make the first choice. I'm sure it's barbaric and sounds horrible, but I don't know what other choice there was?

imenid37 · Dec 5, 2006

I agree w/ Mom23. I'd go for the c/s myself. We do have a local box ready w/ lido and lido/epi to go if needed. I do not think we would sedate first. If it were that urgent they would just do local and cut if we truly couldn't wait for anesthesia. I have been in a circumstance where I wish we would have done this. The outcome was not good. There was a major sudden insult which occurred. We may or may not have had a diferent outcome if we had proceeded w/o anesthia's presence. I think if it happened now, a number of years later, we would have gone ahead.

nuberianne_RN · Dec 5, 2006

I am a nursing student so I am not comprehending this at all. If someone shows up at this hospital conscious but with a massive bleed somewhere who is going to administer the anesthesia to that pt? Another question, if the pt had an epidural that had not been effective who administered it? I guess I don't understand how hospitals operate without someone in house to be available for emergency surgery.

If anyone has to cut me wide open while I am fully awake because there is no doctor or CRNA available, I will sue the pants off of everyone I saw from the minute I walked in the hospital up until the minute I left. Maybe my comments sound ignorant, but I am only in my first semester of my adn program so I have not had any OR or L&D training yet. I am just commenting from a layperson's point of view.

allnurses Guide · Dec 5, 2006

We can call our CRNA in the middle of the night to place an epidural. He will stay awhile to monitor the patient for any negative effects and then he can go home (10 minutes away). If we need to redose, the ob doc can do that.

What probably happened here is the epidural was placed and the CRNA left. I would wonder about the fact that the epidural didn't "take" though. Our CRNA stays until the patient is w/o pain.

Lots of loose ends with this story . . . .

As to suing a hospital that didn't have an OR crew in-hospital, you have to make allowances for rural hospitals. There is no way to have in-house 24/7 OR staff.

We have the staff in the ER to stabilize and get things ready for the crew to arrive in 30 minutes though . . . many of our staff live 10 to 20 minutes from the hospital.

steph