OB Anesthesia Review and Pearls

A-OK Protocol

Used in amniotic fluid embolism

• Atropine 1mg for vagolysis
• Ondansetron 8mg for serotonin receptro blockade and vagolysis
• Ketorolac 30mg for thomboxane production blockade

Breast Feeding and Anesthesia

C-Section Plan

• EKG leads on before the spinal goes in, to monitor for bradycardia
• Pitocin 30un in 500cc LR
  • Give 250cc bolus then trickle
• ABX
  • Ancef for scheduled C/S
  • If laboring Ancef and Azithromycin
  • Chorio: Amp and Gent
  • Clinda if PCN allergy
• Epidural
  • 2% Lido 10-20cc
  • or 10-15cc chloroprocaine
    • Must redose every 30min 5cc

If epidural bolus fails then take out and place spinal 1.6-1.8

• GETA
  • 0.5MAC Des with 50% nitrous
  • 7.0 ETT
• Emergency
  • iStat before transfusing

D/C

• Mac if less than 12 weeks

Full Stomach Guidelines

• 12 weeks until 2 weeks postpartum

Retained Products of Conception

• Low dose spinal 1.2-1.4 or tube

Labor Epidural Plan

Do not do if platelets are less than 100k

• 0.2% Ropi plain
  • 5-10cc bolus with 50-100mcg fentanyl
  • Infusion 10cc/hr, 5cc bolus, 30min lockout
• Vitals q5 for 15min, q15min for 1 hr, q30 after that
• Top Off
  • 0.25% Bupivacaine 5-10cc
  • 2% lidocaine 5-10cc

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