Algorithm for the anesthetic management of cesarean delivery in patients with unsatisfactory labor epidural analgesia.

Sonia Vaida,Debra Hurwitz,Davide Cattano,Berend Mets

doi:10.12688/f1000research.6381.1

Sonia Vaida, Debra Hurwitz + Show 2 more

Open Access

https://doi.org/10.12688/f1000research.6381.1

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Journal: F1000Research	Publication Date: Apr 24, 2015
Citations: 6	License type: CC BY 4.0

Affiliation: Penn State Milton S. Hershey Medical Center

Abstract

The management of a patient presenting with unsatisfactory labor epidural analgesia poses a severe challenge for the anesthetist wanting to provide safe anesthetic care for a cesarean delivery. Early recognition of unsatisfactory labor analgesia allows for replacement of the epidural catheter. The decision to convert labor epidural analgesia to anesthesia for cesarean delivery is based on the urgency of the cesarean delivery, airway examination, and the existence of a residual sensory and motor block. We suggest an algorithm which is implemented in our department, based on the urgency of the cesarean delivery.

Highlights

Neuraxial blockade in obstetric anesthesia is considered the preferred method of analgesia for both vaginal and surgical deliveries
We suggest an algorithm to help guide anesthetic management in a situation where epidural analgesia is insufficient and anesthesia is requested for Cesarean delivery
Summary In summary, the management of a patient with unsatisfactory labor epidural analgesia poses a severe challenge for the anesthetist wanting to provide safe anesthetic care for a cesarean delivery

Summary

Introduction

Neuraxial blockade in obstetric anesthesia is considered the preferred method of analgesia for both vaginal and surgical deliveries. Category 2 cesarean delivery (Figure 2) A more thorough assessment of the neuraxial block can be performed and should include the height, density and distribution of analgesia (unilateral or bilateral). Epidural sensory block should be assessed for the highest dermatomal level at which the patient is able to detect a controversial, a continuous spinal catheter is a viable option for cesarean delivery after failed epidural analgesia[34]. This option should be considered especially in patients where previous attempts to rescue labor epidural analgesia have been performed (withdrawal of the epidural catheter by 1 cm followed by top-up with local anesthetics and opioids). Grant information The author(s) declared that no grants were involved in supporting this work

Hogan Q

24. Jenkins JG

27. Yentis SM

30. Menon R

34. Palmer CM