C-Section

Question 1

Pitocin (formulation and dosing)

Answer 1

*Administered after delivery of baby.
*30units Pitocin/500cc bag
* 300cc/hr if patient not previously on pit, 600cc/hr (maybe-start at 300) if previously on Pit.
*MAX rate is 900cc/hr, can cause hypotension and chest pain.
Consider other uterinetonics.

Start Pitocin after cord clamp. Turn down to 60cc/hr for PACU.

Question 2

Non urgent section : working epidural

Answer 2

10-20cc of 2% lidocaine with 1:200,000 (5mcg/ml)epinephrine with 1cc Bicarbonate per 10cc local to obtain T4 level.

Question 3

Working epidural : URGENT section

Answer 3

15-20 cc of 3% chloroprocaine with 1cc of Bicarbonate per 10cc of local.

3.5mg Duramorph AFTER cord clamp

Question 4

Methergine

Answer 4

2nd line uterinetonic.
Route: IM (Deltoid). 0.2mg
Nausea, vomiting
* contraindicated in hypertension/preeclampsia
*can redose after 2 hours

Question 5

Carboprost/Hemabate

Answer 5

*Synthetic prostaglandin
*Route: IM, 250mcg. can redose every 15 minutes
*2nd line tx for uterine atony
* contraindicated in pts with significant asthma as can cause bronchospasm and intrapulmonary shunting

Question 6

C SECTION CSE

Answer 6

1.6 mL Spinal Bupiv (0.75%) with 15mcg Fentanyl and 150mcg Duramorph. And 100mcg (0.1ml) Epinephrine. (Draw up in TB syringes separately).