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Obstetric crib sheet
Peter Dzendrowski
Combined spinal & epidural
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CSE SECTION |
2 2.5 mls heavy marcain + 25 mcg fentanyl in spinal
If using saline push technique, use 1.5 2 mls heavy marcain w/
fentanyl
Post-op: 2.5 mg Diamorphine in 10 mls saline via epidural + 100 mg
Voltarol pr
Can have 12 hourly Diamorphine |
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CSE LABOUR |
Spinal starter 1 ml 0.25 plain marcain + 25 mcg fentanyl. Then
usual LDE mix |
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MANUAL REMOVAL OF PLACENTA |
Spinal block to T6: 2mls heavy marcain or epidural top up |
Epidural
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LOW DOSE MIX |
0.1% bupivicaine + 2 mcg/ml Fentanyl = 78 mls N-Saline + 20 mls 0.5%
bupiv + 200 mcg Fentanyl |
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1ST DOSE |
Either 15 mls of LDE mix or 10 mls 0.125% bupivicaine + 50 mcg Fentanyl |
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TOP UPS |
10 15 mls LDE mix 30 min prn. 2nd stage or escape
analgesia: 10 mls 0.25% Bupiviacine every 45 mins |
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LSCS TOP UP |
EITHER: 20 mls 2% Lignocaine + 1/200,000 adrenaline + 100 mcg fentanyl
in 5-10 mls boli
OR: 10 mls 2% Lignocaine + 10 mls 0.5% marcain +1/200,000 adrenaline +
100 mcg Fentanyl in 5 10 ml boli |
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2ND STAGE |
10 20 mls LDE mix OR 10 mls 0.25 marcain |
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OPERATIVE VAGINAL DELIVERY |
as with 2nd Stage +/- extra 50 mcg Fentanyl |
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URGENT DELIVERY WITH INADEQUATE BLOCK |
10 mls 2% Lignocaine +/- 10 mls 0.5% marcain in 10 ml bolus once only |
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POST OP ANALGESIA |
NO systemic opioids within 6 hrs of spinal/epidural opioids
2.5 mg Diamorphine via epid 12 hrly + regular Voltarol OR: IM OR PCA
opioids |
Miscellaneous
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PIH/PET |
FBC/Platelets/Clotting before epidural: Plts >100, OK; 80 100,
OK if clotting OK; <80, no epidural
run them dry-ish use CVP (risk of pulmonary oedema)
Urgent LSCS, use epidural, NOT spinal or GA if at all possible |
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NSAIDS +EPIDURAL |
low dose aspirin OK |
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CLEXANE |
epidural inserted or removed after 12 hrs post administration |
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HEPARIN |
epidural OK after 6hrs post administration |
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EMERGENCY LSCS |
use CSE or spinal or epidural top up |
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TRUE EMERGENCY LSCS |
eg cord prolapse with fetal bradycardia use GA |
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HAEMORRHAGES |
Placenta praevia if anterior, then GA, because need to cut through
placenta
Abruption if stable, then consider regional, but any doubt, then GA |
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DURAL TAP |
Resite epidural, anaesthetist to do top ups labour and delivery as
normal
After delivery, 50 mls N-Saline down epidural, bed rest, well hydrated,
analgesics + caffeine
Blood patch after 24hrs if not resolved and not pyrexial |
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DVT PROPHYLAXIS |
MODERATE RISK: obese > 80kg, age >35, PET, Emeregency LSCS = TEDS
HIGH RISK: 3+ of moderate risk + hx of DVT/PE, extensive surgery = TEDS
+ clexane 40 mg for 5 days |
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GA |
Preload and fully preoxygenate
RSI with Thiopentone 425 mgs + Sux 100 mg + cricoid pressure
50:50 O2:N2O with 0.75 MAC + small dose Atracurium
After delivery: O2:N2O as normal, Opioid analgesia, antibiotics,
antiemetics
Reversal and extubate on side |
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DRUGS IN PREGNANCY |
Metoclopramide / Cyclizine / Stemetil / Ondansetron
Paracetamol / NSAIDS / Morphine |
© Peter Dzendrowski September 1999
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