Epidural top-ups for category I/II emergency caesarean section should be given only in the operating theatre

Russell, I.F.

doi:10.1016/j.ijoa.2004.07.004

Cited by 6 publications

(3 citation statements)

References 30 publications

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“…It should be mentioned that despite importance of investigating optimal epidural augmentation medications, dosage, and adjuvants, there is still no commence the CD early on. On the other hand, in most hospitals (81%), the patient is not monitored while being transferred to the operating room, raising the risk of unnoticed complications, such as high block or total spinal anesthesia, acute hypotension and inadvertent intravascular injection (21)(22)(23). Literature does not specifies guidelines for monitoring during patient transfer.…”

Section: Discussionmentioning

confidence: 99%

Epidural augmentation for urgent Cesarean Section : a nationwide Israeli survey

Giladi¹,

Shatalin²,

Weiniger³

et al. 2021

Acta Anaest Belg

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Background : Epidural augmentation to convert analgesia to emergency cesarean delivery anesthesia is a common practice. In this survey we examined the common augmentation practices in different hospitals in Israel. We investigated whether practices vary by hospital size and if written protocols for conversion correlate with intra-hospital homogeneity. Methods : A questionnaire containing 39 questions was sent to obstetric anesthesia unit heads and to four additional anesthesiologists (attending and residents) in 24 obstetric anesthesia units nationwide. Answers were received online anonymously using web-based survey site. Results : 99/120 participants responded to the survey. 80% of large hospitals have a detailed epidural augmentation protocol. The existence of a written protocol does not affect intrahospital management variability. Overall, 18 different drug mixtures for epidural augmentation were reported, and the most used drug combination is lidocaine, fentanyl and bicarbonate. In large hospitals, 72% add epinephrine and 96% initiate augmentation before operating room arrival. Most respondents reported a final administered total volume of 15-20 ml. In most hospitals there is no maternal or fetal monitoring during patient transfer from delivery room to the operating room, lasting 3.68 minutes on average, with a relative low risk of significant complication as a result of augmentation. Conclusion : We report variations in common practices, depending on hospital size. We recognized low rate of intra-hospital concordance between centers with or without a written protocol of augmentation. Regarding points for improvement, we would recommend adhering to the accepted institutional protocol.

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Section: Discussionmentioning

confidence: 99%

Epidural augmentation for urgent Cesarean Section : a nationwide Israeli survey

Giladi¹,

Shatalin²,

Weiniger³

et al. 2021

Acta Anaest Belg

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“…19 The potential hazards of this practice included severe hypotension, total spinal and local anaesthetic toxicity. 20 Although good arguments exist to favour this practice in obstetrics, these arguments might be negated by the potential difficulties of managing these complications in a morbidly obese parturient in a delivery room. Furthermore the onset of motor block will prevent the parturient from selfpositioning on the operating table; a potentially time saving manoeuvre.…”

Section: Provision Of Anaesthesiamentioning

confidence: 99%

The 30minute decision to delivery time is unrealistic in morbidly obese women

Lucas

2010

International Journal of Obstetric Anesthesia

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“…[18][19][20][21] The absence of a randomised trial of early versus delayed delivery precludes firm conclusions, and interpretation of audit data is fraught. 19,22,23 A number of authors have suggested that delivery intervals exceeding 30 min are acceptable. 12,19,20 4.…”

Section: Reduction In Decision-delivery Time Improves Fetal Outcomementioning

confidence: 99%