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

Moore, Phil

doi:10.1016/j.ijoa.2004.07.003

Cited by 7 publications

(4 citation statements)

References 27 publications

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“…My preferred choice of local anaesthetic is levobupivacaine, the S-enantiomer of bupivacaine, which is less cardiotoxic than racemic bupivacaine in the event of accidental intravascular injection. Whether the top-up should be administered in delivery room or theatre is controversial [17]. Topping-up in the delivery room might gain time, but maternal monitoring is suboptimal when the risk of high block or systemic local anaesthetic toxicity is greatest.…”

Section: Epidural Top-upmentioning

confidence: 99%

Emergency Caesarean section: best practice*

Levy

2006

Anaesthesia

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Good multidisciplinary communication is crucial to the safe management of women requiring non-elective Caesarean section. Anaesthetists should participate actively in resuscitation of the fetus in utero; relief of aortocaval compression is paramount. Epidural top-up with levobupivacaine 0.5% is the anaesthetic of choice for women who have been receiving labour epidural analgesia. If epidural top-up fails to provide bilateral light touch anaesthesia from S5 -T5, a combined spinalepidural technique with small intrathecal dose of local anaesthetic is a useful approach. Preeclampsia is not a contra-indication to single-shot spinal anaesthesia, which is the technique of choice for most women presenting for Caesarean section without an epidural catheter in situ. Induction and maintenance doses of drugs for general anaesthesia should not be reduced in the belief that the baby will be harmed. Early postoperative observations are geared towards the detection of overt or covert haemorrhage.

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Section: Epidural Top-upmentioning

confidence: 99%

Emergency Caesarean section: best practice*

Levy

2006

Anaesthesia

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“…5 The potential for high block or intravenous toxicity occurring in the labour room or, worse still, during transfer to the operating theatre must be borne in mind if this recommendation is followed. 26 Our questionnaire did not ask where anaesthetists started the epidural top-up, as it was designed before the publication of this report.…”

Section: Epidural Top-up For Emergency Caesarean Sectionmentioning

confidence: 99%

Obstetric epidural test doses: a survey of UK practice

Gardner

Kinsella

2005

International Journal of Obstetric Anesthesia

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

Cited by 7 publications

References 27 publications

Emergency Caesarean section: best practice*

Emergency Caesarean section: best practice*

Obstetric epidural test doses: a survey of UK practice

Epidural augmentation for urgent Cesarean Section : a nationwide Israeli survey

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