Well...we have to post the good with the bad..so here is my bad:

G1P0 4'11, 160# Female in labor, dilated 3-4 cm. Another provider put a labor epidural in @ 5pm L2-3, 13cm skin. Bolus 6ml of 0.125% marcaine with 2mcg/ml fentanyl, infusion @ 6ml/hr with PCEA 4ml q 20min, lockout 3 X's in 1 hr.

As you may have guessed, I get called in an hour...block inadequate..but I'm in OR... Right side no block, Left side T12. I have the nurse turn the patient full Right lateral and push the PCEA button. An hour later I get to the patient. She has bilateral T11 level but feels each contraction in her perineum..Rates 5. So she's places supine with slight left tilt and bolused 5ml 0.25% Bupivicaine with 50mcg fentanyl. Epidural rate increased to 9ml per hour. PCEA changed to 4ml q 30 min, lockout 2X's per hour.
I ended up bolusing her another time...perineum never got good relief...then BLAM...C section at 11pm...What to do..what to do??

Here's the ? you have to ask yourself...use the epidural and hope for the best?? Could never get greater than T11 level.
General Anesthetic??
Spinal??

I chose spinal....have never done it after epidural..but what the hell..

Dose: 1.2 ml (9 mg) with 15mcg fentanyl...placed in slight reverse trendelenberg...
2 min....pt states that its more difficult to breathe....getting fidgety and nervous. 4 minutes...can barely phonate..unable to grip...O2 sat decreased from 98%-94%...so..cricoid...mask over face...back to 99 % and I RSI...she buys the ventilator for an hour after the case....

Alright..discussion??