The Epidural Insertion |

Описание: Check out our labour epidural playlist for a safe approach to epidural insertion as a trainee anaesthetist/anesthesiologist

for your preparation:
1 Equipment opened carefully on sterile field
2 Eye protection + mask on (not demonstrated here)
3 Surgical scrub and sterile gown & gloves

Patient positioning:
• Relaxed shoulders, chin to chest
• Thighs parallel to bed, knees bent to 90 degrees with feet on a stable surface
• Hug pillow to help curve spine
• Maximise curvature of lumbar spine

Careful with chlorhexidine!
• Ensure the 0.5% chlorhexidine is dry prior to draping and starting the procedure
• Higher concentrations of chlorhexidine are associated with increased neurotoxicity
• Avoid chlorhexidine prep on your sterile field as much as possible. Have an assistant prep the back or do this yourself prior to surgical scrub
• If using chlorhexidine liquid, ensure it is tinted and do not place it on your epidural set up in one of the pots. This can result in catastrophic neurotoxicity if it is used instead of normal saline in the loss of resistance syringe.
• We strongly advise you apply the prep and allow it to dry as a separate procedure to the epidural itself to avoid any inadvertent errors.


Epidural observations from test dose = refer to local guidelines.
As an example:
• Continuous CTG, observe for LAST (local anaesthetic systemic toxicity) throughout
• 5 minutely foetal heart rate, maternal heart rate, SpO2 & BP for first 30 minutes then 30 minutely until birth
• Sedation score, respiratory rate,
• Sensory and motor block assessment at 30 minutes then hourly until birth’

NOTE:
• BP should remain stable after test test.
• Ensure BP is kept within 10% of baseline as placental blood flow is not autoregulated


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