Assessment for Anaesthesia for Caesarean Delivery

Question 1

1. Preoperative Assessment:

Answer 1

1. Physical Examination: identify if patient is high risk for PPH ( 1.5; PTT > 1.5
2. Septic pt.
3. Infection over site of injection
4. Allergy to LA

Question 2

2. Preoperative Equipment Check:

Answer 2

1. Anaesthesia Machine Check
2. Tilting table with lateral arm supports
3. Anaesthetic wedge
4. Suction apparatus, tubing and Yankuaer nozzles

Question 3

3. Resuscitation Equipment Check:

Answer 3

1. Ambubag

2. Defibrillator & how to use it

Question 4

4. Intubation Equipment Check

Answer 4

1. Check airway trolley

Question 5

5. Preparation Patient:

Answer 5

1. Premedication - sodium citrate 30ml orally 0 - 30 mins pre-op
2. Preload - good IV access with 500ml clear fluid
3. Urinary catheter
4. Consent

Question 6

6. Draw up-essential drugs:

Answer 6

1. Phenylephrine
2. Ephedrine / Atropine
3. Syntocinon

Question 7

7. Spinal Technique:

Answer 7

1. Measure NIBP before starting, set NIBP to read at l min intervals
2. AND feel for volume of patient’s pulse
3. AND apply pulse oximeter
4. AND apply ECG
5. Administer 500ml of Ringer’s lactate (or similar) while performing spinal

Question 8

8. Lumbar Puncture technique:

Answer 8

1. Appropriate needle insertion technique and direction
2. Understanding of spinal anatomy
3. Use of Pencil Point Needle and method

Question 9

9. Actions after Spinal administered:

Answer 9

1. Wedging
2. Head and Shoulders raised
3. Monitored NIBP at 1 min intervals
4. Communicate with patient 5. Continue careful fluid administration
5. 40% Face mask O2
6. Rapid administration of vasopressor and/or prophylactic infusion if any signs of hypotension
7. Assessment of level of block, knowledge of required level for CD

Question 10

10. Haemorrhage management:

Answer 10

1. Understanding risk factors for haemorrhage
2. Knows when bleeding is excessive e.g. HD compromise, >lL blood loss
3. Appropriate oxytocin Mx (2.5 + 20U at 125ml/hr)
4. Further Mx if uterus atonic: Ergometrine / Cytotec / Tranexamic acid

Question 11

11. Recovery Mx:

Answer 11

1. Understands need for recovery
2. Documents level of spinal and completes postoperative charts
3. Checks for PPH: haemodynamics & visible bleeding and palpates if uterus well contracted
4. D/C criteria after neuraxial anaesthesia

Question 12

12. Knowledge of action if cardiac arrest:

Answer 12

1. Informs team and call for help
2. Deliver baby urgently (within 4 min)
3. Immediate chest compressions
4. Immediate manual displacement of uterus
5. BMV airway Mx
6. Intubation
7. ADR bolus 1 mg each 3 minutes

Question 13

13. Knowledge of action if failed spinal:

Answer 13

1. Wait at least 20 min
2. Immediate conversion to GA - very early in procedure, won’t tolerate ketamine boluses
3. Supplementation and top up with local and N2O and ketamine - later on in procedure, surgery nearly complete
4. Wait and repeat spinal - NOT advised - risk of high/total spinal with too much volume given
5. Abandon Local attempt and refer - multiple attempts spinal in high BMI

Question 14

Order

Answer 14

1. Pre-op assessment
2. Pre-op equipment check
3. Resus equipment check
4. Intubation equipment check
5. Preparation of patient
6. Draw-up essential drugs
7. Spinal technique
8. LP technique
9. Actions after spinal - position + monitoring
10. Haemorrhage Mx
11. Recovery Mx - Monitoring + D/C
12. Knowledge if cardiac arrest
13. Knowledge if failed spinal