1.4 General Anaesthesia for Caesarean Section

Question 1

Indications for GA section

Answer 1

1. Urgency of Caesarean section: maternal or fetal risk of morbidity or mortality
2. Failure or inability to perform regional technique
   spinal abnormal / morbid obesity
3. Failure regional anaesthesia
   provide adequate blockade

4. Contraindication to performing regional technique
maternal refusal
coagulopathy
thrombocytopaenia
local infection

5. Severely compromised / altered maternal CVs physiology
   - haemorrhage / cardiac disease
6. Elective / Semi Elective cases
   high risk haemorrhage
   placental implantation syndromes

Question 2

Outline preoperative prep and management

Anesthetic induction for fetal brady

Answer 2

Equipment and Drugs checked

Pre-assesment

In theatre

Induction

Question 3

Pre-assessment

Answer 3

1. May have minimal time
   - concise
2. Past anaesthetic Hx
   FH of probs
3. PMH / Drug history / Allergies
4. Last food and drink
5. Airway
6. Consent
   RSI / Cricoid / Sore throat / Dental damage / postop analgesia myalgia
7. Commence in utero resusc
   Left lateral tile
   Administer IV fluids + O2
   Stop synto infusion

Question 4

In OT

Answer 4

1. Reattach CTG
2. Check if time for regional technique
3. AAGBI monitoring
   induction on Op table
4. 1 /+ wide bore cannula in + check patency
   FBC U+E Clotting and Xmatch
5. Left lateral tile or wedge on OT - prevent AOC compression
6. Antacid prophylaxis
   ?IV ppi / prokinetic
   Sodium citrate 30mL 0.3M
7. Bladder catheterised
   Skin prepped and draped
   Surgeon scrubbed and ready to operate prior to induction

Question 5

Induciton

Answer 5

1. Pre O2
   Head up 100% - tight fitting mask >3m / 5 VC breath
2. Traditional -
   Thio 5mg/kg lbw
   Sux 1.5g/kg
   simultaneous cricoid as consciousness lost
3. Intubation trachea
   Confirm capnography / bilateral chest expansion and auscultation
4. Maintenance anaesthesia
   Muscle relaxation
   O2 Volatile
   NDMB
5. Consideration of opioids
   obtund laryngoscopy pressor effect in P-Eclamp
   Cardiac disease
   Must tell Paeds