Ok so I know there are a lot of grey areas in the C-section realm of OB anesthesia. I am trying to enhance communication with our OB guys when they call a C-section. I am in a small community hospital 3 OR's, 3 CRNA's, no dedicated OR for OB. 2 OB docs. Most of our communication with OB and C-sections actually comes from the nurses on OB who will call down to the OR (or call anesthesia). They will either say, "we need to do a C-section stat" or we need to do a C-section as soon as a room opens up. I guess it is my fault for not communicating directly with the OB doc, hence I'm meeting with an OB doc tomorrow to try to figure out how better to know what type of anesthetic would be best for the C-section. Our hospital policy currently reflects the ACOG standard of decision to incision in 30 minutes or less for a STAT (emergent) C-section. Reasons for STAT section include prolonged fetal deceleration or repetitive deceleration, abruptio placenta with or without heavy bleeding, placenta previa with heavy bleeding, suspected uterine rupture, or physician determination that immediate delivery is necessary. If it is a true stat, we proceed with general anesthesia. The next type of C-section is classified as "urgent", and the policy states the infant needs to be delivered as soon as the next available operating room is ready from the time the physician states the need for the c-section due to maternal or fetal factors. Huh? Anyways there is definitely more than that from the anesthesia perspective. So, I am thinking there should be more classifications than this that will influence our anesthesia of choice, one of which is considering the NPO status. My questions are as follows:
1. Type of anesthetic for truly STAT,emergent C-section (General?)
2. Type of anesthetic for Urgent, over 6 hours NPO solids, no existing epidural, no contraindication for spinal (Spinal?)
3. Type of anesthetic for Urgent, under 6 hours NPO solids,no epidural surgeon says it can't wait until appropriate NPO status (General?)
4. Type of anesthetic for Urgent, over 6 hours, good working epidural (Use existing epidural?)
5. Type of anesthetic for Urgent, under 6 hours NPO solids, good working epidural (Use existing epidural or general?)
6. Type of anesthetic for ASAP...follow NPO guidelines if no existing epidural (epidural or spinal)
7. Type of anesthetic for our routine C-sections is usually spinal with Astramorph.
I know some of our anesthetic decisions are based on information obtained from OB nurses and our OB docs. The OB docs here really love spinals with astramorph or epidurals with astramorph.
What are your policies relating to anesthesia and C-sections, and based on your experience what do you have in writing in your policies? What type of anesthesia would you use in the above scenarios? Thanks in advance for all your experienced input!!!