Anaes SAQs · Obstetric anaesthesia
Caesarean anaesthesia: technique choice, phenylephrine, and Category 1 GA
Final-examination SAQ.
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Options (4). Assess epidural for rapid top-up densification versus new spinal/CSE versus GA. Prefer neuraxial if time and block quality allow; abandon patchy epidural early if inadequate.[6]
Spinal recipe and hypotension (6). Hyperbaric bupivacaine about 10–12.5 mg with fentanyl 15–25 microg (unit-protocol teaching ranges) and morphine about 75–100 microg IT (little justification above 0.1 mg in-trial); phenylephrine first-line 50–100 microg ward boluses with infusion titrated to near-baseline systolic (in-trial 100 microg/min start), uterine displacement, co-load; better fetal acid-base than ephedrine (UA pH +0.03, no difference in true acidosis or Apgar).[1][3][7]
Category 1 GA (5). Help, preoxygenation, obstetric RSI, videolaryngoscope readiness, OAA/DAS failed intubation, short induction-to-delivery, oxytocin after delivery, awareness risk mitigation.[6]
References8ShowHide
- [1]Lee A, Ngan Kee WD, Gin T A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg, 2002.PMID 11916798
- [2]Cooper DW, Carpenter M, Mowbray P, et al. Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology, 2002.PMID 12459688
- [3]Ngan Kee WD, Khaw KS, Ng FF Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Caesarean section. Br J Anaesth, 2004.PMID 14977792
- [4]Ngan Kee WD, Khaw KS, Tan PE, et al. Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology, 2009.PMID 19672175
- [5]Singh PM, Singh NP, Reschke M, et al. Vasopressor drugs for the prevention and treatment of hypotension during neuraxial anaesthesia for Caesarean delivery: a Bayesian network meta-analysis. Br J Anaesth, 2020.PMID 31810562
- [6]Mushambi MC, Kinsella SM, Popat M, et al. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia, 2015.PMID 26449292
- [7]Palmer CM, Emerson S, Volgoropolous D, et al. Dose-response relationship of intrathecal morphine for postcesarean analgesia. Anesthesiology, 1999.PMID 9952150
- [8]Carvalho JC, Balki M, Kingdom J, et al. Oxytocin requirements at elective cesarean delivery: a dose-finding study. Obstet Gynecol, 2004.PMID 15516392