Hey guys, CA1 here. I just wanted to get your thoughts on how you would approach a spotty epidural during C-section?
What I've been doing is obviously re-dose epidural with 2% lido + epi (+/- fentanyl) up to 20cc, then I would go to 3% chloro. From here, I've had attendings do many different things. Most of them start working in some ketamine (10mg a time), some give midaz, rarely give IV fentanyl (until the baby is out).
I was also wondering, is there any specific contraindication to giving ketamine or midaz to the mother before the baby is out? Obviously you wouldn't give IV opioids before the baby's out to avoid any respiratory issues, but is there anything about ketamine/midaz?
What I've been doing is obviously re-dose epidural with 2% lido + epi (+/- fentanyl) up to 20cc, then I would go to 3% chloro. From here, I've had attendings do many different things. Most of them start working in some ketamine (10mg a time), some give midaz, rarely give IV fentanyl (until the baby is out).
I was also wondering, is there any specific contraindication to giving ketamine or midaz to the mother before the baby is out? Obviously you wouldn't give IV opioids before the baby's out to avoid any respiratory issues, but is there anything about ketamine/midaz?