Emergency c-section

Question 1

Dosing of local?

Answer 1

7 mg/kg 0.5% lidocaine with epinephrine
Maximum 60 cc

or 4 mg/kg 0.5% lidocaine without epi
Maximum 30 cc

Question 2

What are side effects of lidocaine (increasing order of toxicity)?

Answer 2

• metallic taste
• perioral numbness
• tinnitus
• slurred speech/blurred vision
• altered consicousness
• convulsions
• cardiac arrhythmias
• cardiac arrest

Question 3

What is the technique of CD under local?

Answer 3

• midline vertical (quicker, less bleeding)
• infiltrate skin and parietal and visceral peritoneum with local
• do not: manipulate bowel, pack gutters, exteriorize uterus
• monitor pt with continuous EKG/SpO2

Question 4

What are perimortem CD and time-associated fetal outcomes?

Answer 4

• best outcomes < 5 minutes
• within 15 minutes > 67% fetal survival
• 16-25 minutes < 40% survival; most are compromised

Question 5

When to perform perimortem?

Answer 5

• ASAP, before CPR.
• CPR provides < 30% normal maternal cardiac output
• Compressions less effective with enlarged uterus