Is it kosher (running epidural w no in-house )

[turnupthevapor]

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At one of my centers we don't have in house attending at night. Our orthopedist wants an epidural running overnight for cpm patient. Do you a all feel comfortable leaving an epidural running with out someone in-house who knows how to manage emergencies. Is there any guidelines for this


Thanks

 

[Planktonmd]

At one of my centers we don't have in house attending at night. Our orthopedist wants an epidural running overnight for cpm patient. Do you a all feel comfortable leaving an epidural running with out someone in-house who knows how to manage emergencies. Is there any guidelines for this


Thanks

What emergencies are you expecting that require the presence of an anesthesiologist?
I am assuming the hospital has an ER physician and some kind of a code team, so if someone has an "emergency" there is someone to manage it.

 

[periopdoc]

Yes it is kosher to run pain epidurals without anesthesia presence for all the reasons Plank mentioned. You could probably argue that the "Standard of Care" is to not have in house anesthesia for these since most practices don't.

A more interesting question is what about running OB epidurals without in house anesthesia. There are places that do this. What do folks think of this practice?

- pod

 

[Fooper]

Absolutely. Running continuous epidural infusions via PCEA (both pain & OB) using dilute local anesthetic/narcotic mixtures is safe, has a high level of patient satisfaction, and does not require an in-house anesthesiologist, provided there is reliable nurse monitoring. So-called "emergencies" are commonly related to epidural boluses, which do require an anesthesiologist, or lapses in nursing care (say it ain't so...)

 

[jennyboo]

At one of my centers we don't have in house attending at night. Our orthopedist wants an epidural running overnight for cpm patient. Do you a all feel comfortable leaving an epidural running with out someone in-house who knows how to manage emergencies. Is there any guidelines for this

We leave post-op epidurals running all the time. As long as you have either a PCEA with standard limits determined by your anesthesia group/department, or infusion parameters determined by your group, and the nurses are comfortable setting them up and refilling them on the floor within your parameters, you should be fine.