C-section under spinal

In obstetrics more than anywhere else, the anaesthetist is an entertainer. Aside from the clinical parts, consider other elements: do they have a playlist they would like to play?

Pre-op

• Antacid prophylaxis
• Paracetamol 1g PO
• Note baseline BP from last antenatal clinic visit

Intra-op

• 2.5ml 0.5% heavy bupivicaine + 300 mcg diamorphine
  • Or 50-100mcg morphine
• Start phenylephrine off at ~20ml/hr (15-30ml/hr acceptable)
  • Aim for systolic ≥ 90% baseline
  • Adjust in 5-10ml increments
• Left tilt on table
• 5 units of oxytocin given slowly after cord clamped*
• Dexamethasone 6.6mg
• Diclofenac 100mg PR by surgeon
• Paracetamol IV if not given pre-op

Documentation

Always document (if true!):

• Sensory block
  • Before start: Cold to T4, light touch to T5
  • By delivery: Light touch S5 to T4
• Motor block: unable to straight leg raise
• Sympathetic block: warm feet
• Mother comfortable throughout
• If there was pain, that you offered analgesia and GA
• Documenting timings is critical here

Post-op

• Paracetamol 1g QDS
• Ibuprofen 400mg QDS (to start after diclofenac worn off)
• Dihydrocodeine 30mg QDS
• Oramorph 20mg 2 hourly PRN
• Lactulose 10-20ml BD
• Ondansetron 4mg PRN

Variations

• Lower doses of uterotonics are now being used- Heesen M, Carvalho B, Carvalho JCA, et al. International consensus statement on the use of uterotonic agents during caesarean section. Anaesthesia 2019;74:1305–19. doi:10.1111/anae.14757