Parturient + for amphetamines on UDS. Labor epidural?

[excalibur]

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28 y/o G1P0 with no other PMH presents for labor. 4 cm dilation. UDS is positive for methamphetamines. Platelets normal. Patient is in severe pain and desires a labor epidural.

Would you place a labor epidural?

Why or why not?

 

[Doctor4Life1769]

Is a positive urine drug screen ever a CI for labor epidural?

No.

So, given normal platelets and coags, I would.

 

[OB1🤙]

Tweakers gonna tweak.

Is she actively high? Vitals, physical exam? Is she an otherwise reasonable, rational person, or an end-stage tweaker?

I *probably* would, assuming her bp isn't 300/200 with a hr of 190, but would have a low threshold for changing my mind if my spidey sense started tingling. Would have a longer than usual talk about risks.

Also, why did she get a UDS in the first place?

 

[excalibur]

Tweakers gonna tweak.
QUOTE]

This was the line of the week for me!! Thanks, HB, for giving me a good laugh to end my call night.

 

[excalibur]

For those that would, any concern about using Epi in the Lidocaine test dose?

 

[sevoflurane]

Nope.

What are the effects of chronic amphetamines and anesthesia?

 

[Doctor4Life1769]

Nope.

What are the effects of chronic amphetamines and anesthesia?

Indirect acting vasopressors aren't going to be effective in managing hypotension. Thus would need to give direct acting agents. Also, would lower MAC requirements in the OR setting.

I also wouldn't be concerned with a test dose of epi.

 

[chocomorsel]

Had this same case in residency. Baby was IUGR because mom was a meth/coke head. Anyway, placed the epidural told her that she would be numb.

A little while later she started freaking out talking about things were crawling on her and it had to be the epidural. I said nope. The epidural is not the cause but likely your Amphetamine/Cocaine use is What is that feeling that drug users get when they feel spiders and bugs on their skin? She kept calling and acting totally crazy, yelling, scratching out her skin, getting all wild with the nurses.

I finally had it, I went in and told her if she didn't calm down, I would pull the epidural. She kept at it and I pulled it. She gave birth without my assistance.

Tweaker's gonna tweak!!!. Funny, but true statement. That biatch was trippin'. My attending was a little upset that I didn't talk to him about it, but the nurses were relieved.