GA - Caesarian Section
Acid aspiration prophylaxis...
Emergency case:
* If Ranitidine not administered during the labour, give 50 mg I.V. immediately.
Diluted into 20 ml saline
* 10 mg Metoclopramide I.V.
* 30 ml oral Sodium Citrate immediately before intubation.
Elective case:
* Ranitidine 150 mg, oral, the night before.
* Ranitidine 150 mg and Metoclopramide 10 mg, oral, 2-4 hours before the procedure.
* 30 ml of 0.3 M Sodium Citrate, oral, immediately before intubation.
Intubation...
- Have second Anaesthetist present
- Confirm choice of airway rescue device (LMA? Proseal?, ILMA?)
- Establish I.V. access
- Place patient in left lateral tilt (maintain until delivery)
- Give 30 ml sodium citrate antacid prophylaxis
- Optimise head/neck position
- Place suction under pillow
- Pre-oxygenate for 3+ minutes
- Commence cricoid pressure when Thiopentone given
- Give 1.5 - 2mg/kg Suxamethonium
- Intubate
- Ventilate with 2% Isoflurane in 50:50 oxygen:nitrous oxide (first minute)
- Reduce to 1% Isoflurane
Failed Intubation
Delivery...
- Immediately after all deliveries, give 5 IU Oxytocin I.V..
- Start infusion of Syntocinon (oxytocin) 40 IU/500 ml saline at 10 IU/hour
- Oxygen concentration can be reduced to 30%
- Ask surgeon if left tilt can be removed
- Give supplemental analgesia: Morphine/Paracetamol/PR Diclofenac
Note: 2 ml of i.v. 1:1,000 Salbutomol, acts as antagonist (relaxes uteris) of
Syntocinon when eg, doing a manual removal of placenta (gives more space for surgeon).
After all deliveries...
* Consider NG tube to drain stomach
* Make oxygen cylinder/hudson mask available