What is look like being an Anesthesia Attending in ObGyn hospital?

[DrAmir0078]

Hi SDN Anesthesiologists,
I hope you are doing well. It has been a while, not that long to write here. I was a bit busy with bureaucracy of where the health directorate of this city would assign me to start my career as an Attending, and guess what (probably you read it and got it in the title), they finally assigned me to a maternity hospital in a district (urban - rural city) 30 miles away from where I live. Next week, I will have 72 hours shift (8 hours daily OR) and the rest in call for emergencies and I will saty these days in the hospital. So, how would it like to be an ObGyn newbie Anesthesia attending? I had read some posts here about being a new Attending. I myself feel a bit foggy, trying to collect myself up; info I had retained so far from the residency seems unwillingly to surface out. I would like here to get your tricks, approaches (any info would be helpful) like : all OBs are full stomach, all OBs for CS are neuraxial unless there is a contraindication, Do not forget the airways to examine bro, left lateral tilting, use smaller tube,,, etc. All these info we were taught during our residency and those books; but practice wise - tricks that are gained from the practice. Any info, it will be of great help.

I am so thankful.


Amir

---

Members don't see this ad.

 

[dabears505]

What percent of patients get epidurals?

 

[DrAmir0078]

What percent of patients get epidurals?

0%, no Epidural sets available (the government health directorate won't supply it - with a hope to bring this up by me to the director of hospital)!
Other hospitals asks the patients to buy it from outside the hospital and bring it with them. I myself have 3 precious sets in my anesthesia bag
Painless labor culture and practice isn't widely used in Iraq unfortunately!

 

[dabears505]

If it's not a production based job, you should be very happy there are no epidural kits.

 

[DrAmir0078]

If it's not a production based job, you should be very happy there are no epidural kits.

With a great regret though

I hope, I can write a request to supply us with epidural kits, but I need some time, I need to feel safe standing on my feet in the practice!

 

[GassYous]

I think a lot of the dogma taught in ob is nonsense. Plenty of places around the world are doing c sections with lmas and no problems. The difficulty of an ob airway is very overblown. The papers were done decades ago with trainees.

 

[DrAmir0078]

I think a lot of the dogma taught in ob is nonsense. Plenty of places around the world are doing c sections with lmas and no problems. The difficulty of an ob airway is very overblown. The papers were done decades ago with trainees.

I recall I had read such thing in those Mcqs books banks (myself had studied 19 review books with over 5k SBAs); and I can guarantee I can't remember 80% of them, and what I recall specifically - if you failed to put ETT in emergency CS, put LMA based on the algorithm.
I overhead some Attendings here do it too, but for me I am skeptical!

 

[Angus Avagadro]

How will you manage the spinal headaches without epidural needles? You will have a higher rate of headaches than if you had access to epidural for labor and c sections? The other issue is blood availability. It can get a little nerve racking when they cut into a uterine sinus and you have a 20 g in. Do they do Gyn Oncology there? Also an opportunity for big blood loss. Good luck on your new career!

 

[ERRES2288]

I recall I had read such thing in those Mcqs books banks (myself had studied 19 review books with over 5k SBAs); and I can guarantee I can't remember 80% of them, and what I recall specifically - if you failed to put ETT in emergency CS, put LMA based on the algorithm.
I overhead some Attendings here do it too, but for me I am skeptical!

Yes, if stat general and can’t intubate then LMA and tell them to cut.

 

[DrAmir0078]

How will you manage the spinal headaches without epidural needles? You will have a higher rate of headaches than if you had access to epidural for labor and c sections? The other issue is blood availability. It can get a little nerve racking when they cut into a uterine sinus and you have a 20 g in. Do they do Gyn Oncology there? Also an opportunity for big blood loss. Good luck on your new career!

Thank you.
Never heard one did it or have seen epidural blood patch approache in my residency and just read it. I can recall back in the day in the US when I was working in the ER, I used to see every once in a while a patient with post dural punctuation headache, but none here!
Since it is a district hospital with limited resources and no HDU, the patient would go to the capital city of the province aka State like!
Blood is available, catheter Guage 20 are available, but no CV line
What else we do not have... Happy life!

 

[Angus Avagadro]

Thank you.
Never heard one did it or have seen epidural blood patch approache in my residency and just read it. I can recall back in the day in the US when I was working in the ER, I used to see every once in a while a patient with post dural punctuation headache, but none here!
Since it is a district hospital with limited resources and no HDU, the patient would go to the capital city of the province aka State like!
Blood is available, catheter Guage 20 are available, but no CV line
What else we do not have... Happy life!

Sorry, the 20 g iv reference was to suggest that it would be much too small for rapid blood infusion. I should have been more clear.

 

[sevo00]

The difficulty of an ob airway is very overblown.

Agree with this

 

[DrAmir0078]

Sorry, the 20 g iv reference was to suggest that it would be much too small for rapid blood infusion. I should have been more clear.

Yes, at least it is most of the time are available. 18 G aren't always there, but I assure you that 16 and 14 are extinct.
3 ways port extensions are always not existed. In residency and in the best teaching centers in Baghdad, we either buy stuff, equipments and drugs like (labetalol, phenylephrine,,,, and even Fentanyl) out of our pockets in order we can run the shift hard cases. Other stuff and equipment, we supply our personal anesthesia bag came from collecting from other departments like ENT, Maxillofacial,,, etc

 

[coffeebythelake]

0%, no Epidural sets available (the government health directorate won't supply it - with a hope to bring this up by me to the director of hospital)!
Other hospitals asks the patients to buy it from outside the hospital and bring it with them. I myself have 3 precious sets in my anesthesia bag
Painless labor culture and practice isn't widely used in Iraq unfortunately!

What do women use for analgesia if there are no option for epidural? Opioids? Nitrous oxide?

 

[coffeebythelake]

I think a lot of the dogma taught in ob is nonsense. Plenty of places around the world are doing c sections with lmas and no problems. The difficulty of an ob airway is very overblown. The papers were done decades ago with trainees.

Hold on. Are you talking about LMA for elective c sections? Or for laboring women going for crash c sections? Seems like the risk profile for aspiration is elevated for both but perhaps much higher for the latter.

Is the dogma overblown? I dont know. Gastric ultrasounds do show slowed emptying especially during active labor. Neither case I would use LMA as my default choice when I can have a secured airway with an ETT.

 

[DrAmir0078]

What do women use for analgesia if there are no option for epidural? Opioids? Nitrous oxide?

For NVD, nothing I believe except paracetamol / Pethidine post delivery
For C/S is the same, beside this hospital have Fentanyl
But interestingly, we do TAP with either way blind or to request an US Machine from the floor.
Nitrous oxide, only in the books. Years Years ago was available.
Sometimes we are stuck!