Rapid sequence spinal anaesthesia for category-1 urgency caesarean section: a case series

Anaesthesia
S M KinsellaM J L Scrutton

Abstract

General anaesthesia is the fastest method for anaesthetising a category-1 caesarean section but is associated with increased maternal morbidity and mortality. We describe the 'rapid sequence spinal' to minimise anaesthetic time. This consists of a no-touch spinal technique, consideration of omission of the spinal opioid, limiting spinal attempts, allowing the start of surgery before full establishment of the spinal block, and being prepared for conversion to general anaesthesia if there are delays or problems. We present a case series of 25 rapid sequence spinal anaesthetics for category-1 caesarean section. The mean (SD [range]) decision-delivery interval was 23 (6 [14-41]) min. After excluding cases where there was an identified delay, the median (IQR [range]) time to prepare and perform the spinal was 2 (2-3 [1-7]) min, and time to develop a 'satisfactory' block was 4 (3-5 [2-7]) min. The total time to induce spinal anaesthesia was 8 (7-8 [6-8]) min. There were three pre-operative conversions to general anaesthesia and three women had pain during surgery that did not require treatment. Our data indicate that one might expect to establish anaesthesia in 6-8 min using a rapid sequence spinal. Careful case selection is crucial....Continue Reading

References

Feb 21, 2002·American Journal of Obstetrics and Gynecology·Emmanuel Bujold, Robert J Gauthier
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Citations

May 23, 2012·Journal of Anesthesia·Hiroyuki Sumikura
Dec 31, 2010·Indian Journal of Anaesthesia·Sean Brian YeohAlex Sia Tiong Heng
Mar 29, 2014·International Anesthesiology Clinics·Roanne Preston, Robert Jee
Jun 9, 2012·The Australian & New Zealand Journal of Obstetrics & Gynaecology·Michael Beckmann, Susan Calderbank
Oct 5, 2012·Anaesthesia·D M Hurford, N De Zoysa
Apr 24, 2016·International Journal of Obstetric Anesthesia·R MalhotraA Banerjee
Oct 16, 2010·Anaesthesia·R M Williamson
Jul 21, 2010·Anaesthesia·T Girard, M C Schneider
Mar 24, 2017·Obstetrics and Gynecology·UNKNOWN Committee on Practice Bulletins—Obstetrics
Feb 26, 2019·Obstetrics and Gynecology·UNKNOWN American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics
Sep 10, 2019·British Journal of Hospital Medicine·Frances Young
Oct 3, 2017·Current Opinion in Anaesthesiology·Leslie A SchornackMay C M Pian-Smith
May 31, 2020·Regional Anesthesia and Pain Medicine·Balakrishnan AshokkaVincent Chan
Jun 4, 2020·Regional Anesthesia and Pain Medicine·Harshal D Wagh
May 7, 2020·Current Opinion in Anaesthesiology·Emilia GuaschFernando Gilsanz
May 29, 2015·Journal of Perioperative Practice·Suyogi V JigajinniNadir El Sharawi
May 10, 2020·Regional Anesthesia and Pain Medicine·Joana Santos VarandasHumberto Machado
Oct 28, 2019·Clinics in Perinatology·Nicole L Fernandes, Robert A Dyer
Mar 2, 2021·Current Anesthesiology Reports·Laurence RingCarlos Delgado

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