SUFENTANIL STOCK:  50 mcg/cc

- for initial bolus (0.67 mcg/mL), place 0.2 cc into 15cc bupivacaine

 - for 0.33 mcg/mL infusion, place 0.4 cc in 60cc bupivacaine

LOCAL ANESTHETIC:

1cc 0.25% = 2.5mg

1cc 0.1% = 1.0mg

 INITIAL BOLUS: 

12-15 mL 0.125% Bupivacaine + sufentanil 10 mcg or fentanyl 50-75 mcg

               (or Ropivacaine 0.2% -- same volume and dose of narcotic as with Bupivacaine)

  INFUSION:

1/16 th % Bupivacaine + sufentanil 0.33 mcg/mL  (20 mcg in 60 mL NS) + fentanyl 2 mcg/mL

- run infusion at 12-15 mL/h

(alternative:  Ropivacaine 0.1%  at same rate & same narcotic dose as with Bupivacaine)

 AUGMENTATION BOLUS:

Bupivacaine 0.25% 5-7 mL

or Bupivacaine 0.125% 10-12 mL

or Ropivacaine 0.2% 5-7 mL

 RAPID ACTING / POTENT BOLUS:

3cc Lidocaine 1.5% + epi, then 9-12 mL 0.25% Bupivacaine + 10 mcg sufentanil

or 10-14 mL 1% or 2% Lidocaine

or 10 mL 2% 2-chloroprocaine

COMBINED SPINAL / EPIDURAL (CSE):

- intrathecal dose lasts 90 to 120 minutes

- via 26g pencil point long needle

- solutions are hypobaric.... patient should be flat for 30 minutes

5-7.5 mcg (.1-.15 cc) sufentanil  in 1-2 cc saline

or 2.5-7.5 mcg (.05-.15 cc) sufentanil + 0.5-1 cc 0.25% Bupivacaine

ELECTIVE C-SECTION:

- if no prior analgesia:

2% Lidocaine with epi 1:200 000 

- test dose, then bolus up to  30 mL

- add fentanyl 1 mcg/kg

- add bicarbonate 1 mEq/10 mL to speed onset  & intensify block

- after delivery:  morphine  4 mg  or 3% 2-chloroprocaine (20 cc)  or 0.5% bupivacaine

- plus bicarbonate  0.05 mEq/20 mL

- plus fentanyl 1 mcg/kg

URGENT C-SECTION:

Lidocaine- as in elective C-Section

or  3% Chloroprocaine + bicarbonate 1 mEq/10 mL

MAXIMUM DOSES OF NARCOTIC:

Sufentanil 50 mcg over 12 hours

Fentanyl 250 mcg over 12 hours

ENHANCING LOCAL ANESTHETIC:

- add epi 1:400

- increase bupivacaine to 1/8th% infusion

- add bicarbonate 0.05 mEq/20 mL

OB SPINAL DRUG DOSAGES:

- use pencil point (24 or 25 guage Whitacre, Gertie Marx, or Sprotte needle)

- before block:  1.5 - 2 liters crystalloid or 500 cc Hespan + 1 liter crystalloid

Bupivacaine 0.75% 1.5-1.6 mL (11.25 - 12 mg)

- plus 0.2 mg morphine (0.4 mL)

- plus fentanyl 10 mcg (0.2 mL)

FETAL BRADYCARDIA

Nitroglycerin Lingual Spray - 2 puffs

or Nitroglycerin IV 100-200 mcg  boluses

Ephedrine boluses prn

ASPIRATION PROPHYLAXIS:

bicitra 30 mL po

ranitidine 50 mg iv- night before elective c-section, 150 mg po

metoclopramide 10 mg

Phones:

Codes:

Cohen    P#13021

Ratner    P#13193

Riley       P#13802

Vogel     P#13914