OB Anesthesia

Beginning of the day

Bring donuts, I phone with music
Pick up the phone and key
Take sign out, familiarize with all the patients
Assign all patients with epidurals to you
Check with nurse regarding patient's anesthesia preference
Check OR - make sure to have ETT 6,7 LMAs, LMA supreme

Labor Epidural

Bring tagerderm and tape, Bupivicaine 0.25%

Bicitra and fluid bolus before epidural 

Average epidural space is 5 cm in

Leave 5 cm of catheter in the epidural space

Aspirate before injecting local anesthetic 

Place patient in LUD after epidural injection. Patient will have to switch sides to achieve bilateral block.

Test dose 3cc 1.5% Lidocaine with 1:200,000 epi

Bolus dose - 

< 3cm - 0.125% Bupivicaine. 10cc. Severe pain 15cc.

> 3cm - 0.125% Bupivicaine. 15cc in 2 doses. Severe pain 0.25% Bupivicaine 

> 8cm - 0.25% Bupivicaine 10cc in 2 doses. + Fentanyl 50 mch prn.

Continuous infusion 12-15cc/hour, bolus 12, lock out 12 minutes

For perineal pain Lidocaine 1.5% 12-15cc with patient sitting

Top up

10cc 0.125% Bupivicaine 

10cc 0.25% Bupivicaine 

C-Section

Bacitra and ranitidine 

Bupivicaine 0.75% with dextrose 1.6 cc  + 0.2 mg Morphine (Fentanyl 15-35mcg optional. Last 45 mins)

Left uterine tilt

Phenylephrine, ephedrine, bolus fluid for hypotension

T4 level

Epidural for C-section

Lidocaine 2% + epi + bicarbonate 1mEq per 10cc of Lidocaine 20-30cc

Fentanyl 50mcg

Morphine 4mg after delivery 

Chloroprocaine 15-20cc for STAT section

Pitosin 20 units in first bag of IV fluid and 20 units in the second bag.
If surgeon ask for IV can give 5 units IV if VSS amenable.

GA for C-Section 

Propofol 2-2.5mg/kg, Succinylcholine 1.5mg/kg
Rocuronium 10-20mg
If on magnesium no muscle relaxant is necessary
O2/N2O 50/50 + 1 MAC Sevo
After delivery 70% N2O + 0.5 MAC Sevo , Midazolam 2mg, Fentanyl 200-300mcg
Fully awake and reversed before extubation

Epidural cart code 6789