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ready, Emergency drugs ready • Always ask for blood for any bleeding case Elective/urgent: • Enough time to evaluate Pt, H/P as routine obstetric Hx, and anesthetic Hx with physical exam mainly the A/W, chest, edema …..+ review lab, obstetric consideration • Obtain informed consent from the Pt for neuroaxial block, with risk/benefit discussion, if not C/I for the block. • Pre-meds → GI, other if indicated e.g. asthma, anxiety, endocarditis, steroids • IV → at least 1.5 -2.0 L of fluids • O2, Pre-block V/S • If using hyperbaric L.A lie the Pt down very quickly + LUD, repeat BP • Inform the Pt that if she feel sick to tell me right way (↓BP) • Examine the block by asking the surgeon to use a teeth forceps • As soon as the baby out give synto 5 U then 20 U in the bag
For spinal: 10.5 mg marcaine hyperbaric, 20 ug fentanyl, 150 ug epimorph
Stat: • No time for detailed H/P, pre-meds, life threatening • Do AMPLE history, examine the A/W, V/S, if bleeding have blood • OR ready, A/W equipment (6.0, 6.5 ETT, bougi, LMA), Emerg meds • IV line at least G18, if bleeding another IV G16, • Induction: make sure that the surgeon is ready, Pt is draped, pre-O2, cricoid pressure, RSI with STP 4mg/k, sux 1.5mg/k, consider Ketamine if asthma/bleed • Maintenance: O2/N2O 50/50, low volatile 0.3 to o.5 MAC, do not give any opioids until after baby is out. Then may give morphine/zofran