Page 51 - Part 2 Anesthesiology Common Risk Issues

SVMIC Anesthesiology: Common Risk Issues

available in the main operating suite. In addition, resources for

the treatment of potential complications (e.g., failed intubation,
inadequate analgesia/anesthesia, hypotension, respiratory

depression, local anesthetic systemic toxicity, pruritus, and
vomiting) should also be available in the labor and delivery

operating suite. Likewise, equipment and personnel should be
available to care for obstetric patients recovering from neuraxial

or general anesthesia.

As the ASA notes, the decision to use a particular anesthetic
technique for cesarean delivery is an individualized case-by-

case decision based on anesthetic, obstetric, or fetal risk factors,
the preferences of the patient if available, and the judgment

of the anesthesiologist and the team of treating doctors. The
ASA further notes that regardless of the anesthetic technique

chosen, uterine displacement (usually left displacement) should
be maintained until delivery. This left uterine displacement

position tilts the patient’s abdomen and pelvis at off the midline
by placing a wedge under the right buttock, shifting the uterus

off of the aorta and vena cava. General anesthesia is not
mandated in a caesarean delivery, and anesthesiologists should

consider selecting neuraxial techniques in preference to general
anesthesia for most cesarean deliveries. If the anesthesiologist

decides that a spinal anesthesia is the best option for the
health and safety of the mother and baby, the use of pencil-

point spinal needles instead of cutting-bevel spinal needles is
strongly suggested. However, for urgent cesarean delivery, an

indwelling epidural catheter may be used as an alternative to
initiation of spinal or general anesthesia. This is not to say or

imply that general anesthesia cannot be the best anesthetic
option in some circumstances, and indeed, in deliveries where

there is profound fetal bradycardia, a ruptured uterus, severe

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