Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
as rescue
Dr Shelly Rana
DRPGMC Kangra
What Constitutes Failed Spinal?
Parikh KS, Seetharamaiah S. Approach to failed spinal anaesthesia for caesarean section. Indian
J Anaesth 2018;62:691-7.
Incidence of failed spinal?
Various studies have quoted failure rate up to
17%
Sng BL, Lim Y, Sia AT. An observational prospective cohort study of incidence and
characteristics of failed spinal anaesthesia for caesarean section. Int J Obstet
Anesth 2009;18:237‑41.
Management options ; 3Rs?
Repeat block
Urgent, Category 1
Revive block Caesarean section
• GA rate 7%
• Emergent caesarean
delivery (57.8%)
Use of protocols and
difficult airway
algorithms
Utilization of alternate
airway adjuncts
Improves FRC
IIM Lowers the risk of aspiration
2 min Preoxygenation is
adequate for the term
pregnant woman
UTILIZING
End Tidal oxygen fraction
monitoring
McClelland SH, Bogod DG, Hardman JG. Pre-oxygenation in pregnancy: an investigation using
physiological modelling. Anaesthesia 2008; 63: 259–63.
New techniques for preoxygenation
The proportion with first expired breath etO2 90% was 60%
[95% confidence interval (CI): 54- 66%]
Sun DA, Warriner CB, Parsons DG, et al. The GlideScope video laryngoscope: randomized clinical
trial in 200 patients. Br J Anaesth. 2005;94(3):381-384.
Airway Adjuncts: SGA
Recommendation
If tracheal intubation is not
considered , and there is small
increased concern about
regurgitation risk:
2nd generation SGA is more logical
Pandit JJ, Cook TM, the NAP Steering Panel. NAP5. Accidental Awareness During General Anaesthesia.
London: The Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland, 2014
• RCT: 70 parturients
Group P: 2mg/kg propofol
BIS values from induction to the eighth minute
Group T: 5mg/kg thiopentone
and skin incision, uterine incision and removal
of the infant were lower in Group P.