Complications of Obstetrical Anesthesia Jonathan H. Waters, M.D. Chief, Dept. of Anesthesiology, Magee Womens Hospital Vice Chair for Clinical Research, Dept. of Anesthesiology, University of Pittsburgh Professor of Anesthesiology & Bioengineering, University of Pittsburgh Medical Director, UPMC Patient Blood Management Program Obstetrical Analgesia and Anesthesia • Spinal Anesthesia – Generally used for elective cesarean sections – Single shot Bupivacaine (12 mg) injected into the intrathecal space + morphine – Most common side effect is hypotension – Goal is to provide anesthesia from T4 caudally. • Epidural Anesthesia – Used for labor analgesia – Catheter threaded for continuous analgesia over prolonged period – Can be used for cesarean section by changing the concentration of local anesthetic – Lidocaine 2% + epinephrine 20 mL (400 mg) Test Dose (3 mL of 1.5% Lidocaine with Epinephrine) • Inadvertent subarachnoid catheter placement • Intravenous catheter Epidural Dosing • Bolus-Bupivacaine 0.083% 10 mL + Fentanyl 100 mcg • Maintenance: Bupivacaine 0.083% with Fentanyl 2 mcg/mL • Patient Controlled Epidural Administration • “Crazy Eights” – 8 ml/hr infusion – 8 ml bolus – lockout of 8 minutes – 24 mL one-hour maximum Combined Spinal Epidural Complications following Regional Anesthesia • Local anesthetic toxicity • Total spinal • Postdural puncture headache • Epidural hematoma • Nerve palsy