Page 48 - Part 2 Anesthesiology Common Risk Issues

SVMIC Anesthesiology: Common Risk Issues

of non-particulate antacids, H2 receptor antagonists, and/

or metoclopramide for aspiration prophylaxis. This is to
increase the pH and neutralization of the acid present in

the stomach, which should aid in the reduction of damage
caused by pulmonary aspiration should it occur. H2 receptor

blockers should be used in high-risk situations and should be
administered in the same timing intervals as antacids. When a

maternal patient is in early labor, usually to be considered less
than five centimeters dilation, the timing of neuraxial analgesia

and outcome of labor should include providing patients the
option of neuraxial analgesia when this service is available. A

policy, whether that of an anesthesiologist or facility, preventing
the offer of an epidural based on cervical dilation is usually

ineffective and can cause undue stress in a laboring patient
regarding pain management. Regardless of cervical dilation,

the laboring patient should be offered neuraxial analgesia on
an individualized basis, and patients should be reassured that

the use of neuraxial analgesia does not increase the incidence
of cesarean delivery. The general assumption with a maternal

patient with a history of cesarean delivery was once a cesarean,
always a cesarean. This assumption has been disproved, and

when a maternal patient is attempting a vaginal birth after a
previous cesarean delivery, the anesthesiologist should consider

early placement of a neuraxial catheter that can be used later
for labor analgesia or for anesthesia in the event of operative

delivery. Again, the patient should be reassured that the use of
neuraxial analgesia does not increase the incidence of cesarean

delivery.

When an anesthesiologist is treating a high-risk maternal
patent with conditions such as twin gestation or preeclampsia,

there are anticipated difficulties with the airway, or the patient

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