Conduct of anaesthesia for C-section

Selected Guideline Examples Date
Bolton NHS Foundation Trust Feb 2016
Frimley Health NHS Foundation Trust Dec 2018
The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust
Jun 2017
Lancashire Teaching Hospitals NHS Foundation Trust
May 2016
Wider Scope              
General Points       
  • Good description of top up with bicarbonate lignocaine mixture
  • Doesn't tell you what a good block is only what a poor block looks like
  • "Repeat the spinal after 20 minutes. Give the same dose of heavy Bupivacaine again but omit opioid" - this could lead to an excessive block depending on the individual sitatuion.
  • Prophylactic use of treanexamic acid for high risk cases > 2 previous CS is very controversial
We Liked
  • Post op angalgesia and observations
  • Key Points
  • If an epidural has been sited, ensure it has been removed at the end of surgery, unless there is a good reason to keep it in
  • Clear Guidance on TAP blocks
  • Spinal Anesthesia following inadequate epdiural analgesia
  • Indications for post-delivery Syntocinon infusion
  • Pain during regional anaesthetic very good
  • Guidance on EROS
  • Advice on challenging cases
  • Clear guidance on monitoring in recovery
  • Comprehensive description of Optiflow
  • B@Ease checklist for the obstetric GA
  • Comprehensive
  • Overall quite brief and mostly bullet points. Could be used as a useful check list.
We Didn't like
  • Cautions to intrathecal opioids if eczema or pre-existing itch
  • No cautions around recent epideural top-ups and subsequent dose reduction when removing an epidural and siting a spinal
  • Nothing about topups in room, transfer or cautions
  • GA for Grade 4 placenta praevia
  • Testing block not clear and no mention of motor block
  • Large number of options for epidural top up
  • No advice on where to top up and if started in room advice on monitoring, cell salvage and interventional radiology
  • No mention of DAS failed intubation guidance
  • May still be an excessive dose. No information on more important positioning. If the epidural is not functioning and a spinal is required consider reducing your spinal dose by 10% if a recent epidural Top-Up (20mls) has been given.
  • No mention of motor block. Assess the block height. This must be to light touch and record the level and time clearly on the chart.
  • Block testing section too brief: For a caesarean section you should aim for "anaesthesia to T5", testing using light touch with a neurotip. 1 for forceps and retained placentas to T10 is needed and for perineal work sacral blocks are needed. Remember to check the lower end of your bloc, and for missed segments
  • From a check list to more of a philosophical question. "Not enough detail for a useful guideline. To top up or to spinal? That is the question"
Not Sure


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