Page 46 - Part 2 Anesthesiology Common Risk Issues

SVMIC Anesthesiology: Common Risk Issues

Because neuraxial anesthetics are placed in specific places

in the spinal column, the structure of the spine should be
checked. The skin should be checked for open sores, rashes,

and bruises. Easy bruising can indicate thrombocytopenia,
a condition in which the patient has a low blood platelet

count. The danger in thrombocytopenia is evident as a low
platelet count can prevent clotting. If the anesthesiologist

is treating a maternal patient with confirmed or suspected
hypertensive disorders of pregnancy such as pre-eclampsia

and disorders associated with coagulopathy, consultation
with a hematologist, prior to labor, can help with assessing

the etiology of thrombocytopenia and determining whether
treatment is needed, and also aid in the anesthesiologist’s

decision as to appropriate and safe anesthesia for the patient.
If the anesthesiologist identifies significant anesthetic or

obstetric risk factors, the obstetrician and the anesthesiologist
should consult. In fact, a communication system should be in

place by the facility to encourage early and ongoing contact
between obstetric providers, anesthesiologists, and other

members of the multidisciplinary team. Although a routine
platelet count is not needed with a healthy obstetric patient,

the anesthesiologist’s decision to order or require a platelet
count should be individualized and based on a patient’s history

(e.g., preeclampsia with severe features), physical examination,
and clinical signs. Likewise, a routine blood cross-match is

not necessary for healthy and uncomplicated patients for
vaginal or operative delivery. However, the decision whether

to order or require a blood type and screen or cross-match
should be based on maternal history, anticipated hemorrhagic

complications (e.g., placenta accreta in a patient with placenta
previa and previous uterine surgery), and local institutional

policies.

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