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Discussion

STAT C-Section, Local anesthesia only.

Hello, I am trying to do a bit of research on What Other hospitals are doing in the New England area, regaurding STAT C-Section, where Anesthesia personel are unavailable. I work at a level 2 Hospital, where anesthesia is not present 24/7, and have a 20 minute call back time for OR and Anesthsia (M.D.) personel (CRNA staff have 1 hour). We Have had a situation recently where a STAT C-section was done, and only local was used. Only Staff involved at beging of case was MD & CST, and L&D RN. More specific Question would be this: If this situation would arise at your hospital, Do you have any protocols or policies in place? What do you Use for Local Including:Medications, Dosing, infilltration or Pour In(yes, this is what we've been told). Basically any thing you might do in this situation. Your Best Practice. Thank you in advance for your input.

Angela Lyons RN, CNOR, CLN3

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    • Admin

    Best practice? Have anesthesia available. We have an in house MD and CRNA overnight with additional resources during the day. If L&D is busy, there are additional on call MDs that can be called in. This is done before the need could even arise that a stat section would need to be done without anesthesia availability.

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    Best practice? Have anesthesia available. We have an in house MD and CRNA overnight with additional resources during the day. If L&D is busy, there are additional on call MDs that can be called in. This is done before the need could even arise that a stat section would need to be done without anesthesia availability.

    I don't disagree, but in some hospitals, particularly smaller ones, that's not possible.

    EVERY OB doc should know how to do, or at least start, a C-Section under local. It isn't fun for anyone involved, but it can be lifesaving, and it's certainly possible and do-able.

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    Part of the reason my local hospital started denying VBACs was because they kept no in-house anesthesia crew. Interested/watching this thread.

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    It's awful, horrible. Afterwards the woman should be offered counseling and involved staff should be allowed to debrief and also be offered counseling.

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    I'm shocked that any hospital with OB services isn't required to have Anesthesia in house 24/7 for situations like this! Sounds like the hospital needs to investigate this.

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    I'm shocked that any hospital with OB services isn't required to have Anesthesia in house 24/7 for situations like this! Sounds like the hospital needs to investigate this.

    Look at it from a different perspective - any hospital that doesn't have anesthesia services in-house 24/7 shouldn't be doing OB.

    You're not dealing in reality here. There are tiny hospitals all over the country that SHARE a single anesthesia provider because their volume can't support anyone full time. Yet those 20 bed critical access hospitals attempt to offer OB services, with a lot of those perhaps doing less than 100 deliveries a year.

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    • Experts

    Some facilities are sensitive about employes talking about cases....you should change your name if it is your real one.

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    My SIL is an RT & had to attend at an emergent c-section under local when anesthesia was not available (I don't remember exactly why no one could get there). Traumatic experience for her, especially since she happened to be pregnant at the time.

    One of my instructors is an OB nurse at a small hospital & had that happen to her also on a busy surgical day. Delivery couldn't wait for anesthesia to get out from another case. Stories like these confirmed to me that I want nothing to do with labor/delivery/peds.

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