|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 BIRTHING PARTNER IN THEATRE
- Guidance on EROS
- Advice on challenging cases
- Clear guidance on monitoring in recovery
- Comprehensive description of Optiflow
- B@Ease checklist for the obstetric GA
- 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 |