Walk the line

March 2, 2010

OB Anesthesia can offer a wide entertainment of cases and patients. For example, there is the “uncomplicated” mom who delivers smoothly without complication. There’s the “drug” mom who requests everything under the sun to be comfortable…. or the literal “druggy” mom who is able to tell you where they have the best IV access. Let’s not forget the “perfectionist” mom who has everything planned out from conception to birth. There’s the “multips” who have been through the pregnancy process and are seasoned…. who for the most part are very cooperative and know what to do. The “teeny bopper” moms who often wince at just getting an IV — someone should tell these guys that pregnancy and birth isn’t just about the intercourse and then the baby. There’s the “IVF-ers” who tend to be very nervous about everything along the way, but they’re often the most appreciative of everything you do for them. And finally (maybe I covered them all, but I’m sure I haven’t), there’s the “I just want to be knocked out” mom who basically wants an elective c-section and general anesthesia so they don’t know or feel anything.

Of course, these are just my opinions of the populations I have come across; not true facts. And yes, I realize pregnancy can be a very nerve-racking process. These are just MY descriptors….

Came across an interesting OB anesthesia case. A pt who had an accreta. This was most likely due to her previous 4 c-sections… and she desired a hysterectomy.

Our plan: Multiple large bore PIVs. Arterial line. Type & crossed blood pre-op. Pre-op labs. Blood and fluid warmers. Belmont. Backup RIC and MAC lines available in the room. Peripheral phenylephrine with backup norepi if needed. Epidural anesthesia with backup emergent GA. Constant communication with the surgeons. SICU bed available if needed.

Outcome: Baby delivered and did beautifully. Roughly 1.5L EBL, 2.5L LR. Post hysterectomy ABG with stable Hb. A-line d/c’d. Pt back to OB Labor floor for a couple of hours of monitoring. No SICU bed needed.

Sometimes a full day’s plan helps ward off the evil. It’s nice when you get to deviate away from the “normal” OB anesthetic…and everything goes well. Even if it does seem like over kill.

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