Anaes SAQs · Obstetric anaesthesia
Labour analgesia epidural CSE
Final-examination SAQ for labour-analgesia-epidural-cse.
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Model answer
Consent/contraindications (2). Document consent, platelets/coagulation, sepsis screen, back exam, neuro baseline; contraindications per local obstetric-anaesthesia protocol.[3]
Epidural vs CSE (4). CSE faster sacral onset; both use low-dose LA+opioid maintenance.[1]
COMET (2). 1054 nulliparous; low-dose mobile techniques ↓ instrumental delivery (normal vaginal 42.7-42.9% vs 35.1%, OR ~1.38-1.39) vs traditional; note more Apgar ≤7 / resuscitation with low-dose in-trial.[1]
Breakthrough (3). Assess, position, withdraw catheter, bolus, resite.[1]
RemiPCA (2). Monitored alternative; continuous SpO2/safety system (5740 datasets: no maternal ventilation/CPR, 0.3% possibly related neonatal CPR, 24.7% maternal SpO2 <94%).[2]
CS conversion (2). Top up to surgical T4 if adequate time; if category-1/inadequate prepare GA (OAA/DAS).[3]
References3ShowHide
- [1]COMET Study Group UK. Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial. Lancet, 2001.PMID 11454372
- [2]Melber AA et al. Remifentanil patient-controlled analgesia in labour: six-year audit of outcome data of the RemiPCA SAFE Network (2010-2015). Int J Obstet Anesth, 2019.PMID 30685299
- [3]Mushambi MC 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