Check out our labour epidural playlist for a safe approach to epidural insertion as a trainee anaesthetist/anesthesiologist

for your preparation:
1 Equipment opened carefully on sterile field
2 Eye protection + mask on (not demonstrated here)
3 Surgical scrub and sterile gown & gloves

Patient positioning:
• Relaxed shoulders, chin to chest
• Thighs parallel to bed, knees bent to 90 degrees with feet on a stable surface
• Hug pillow to help curve spine
• Maximise curvature of lumbar spine

Careful with chlorhexidine!
• Ensure the 0.5% chlorhexidine is dry prior to draping and starting the procedure
• Higher concentrations of chlorhexidine are associated with increased neurotoxicity
• Avoid chlorhexidine prep on your sterile field as much as possible. Have an assistant prep the back or do this yourself prior to surgical scrub
• If using chlorhexidine liquid, ensure it is tinted and do not place it on your epidural set up in one of the pots. This can result in catastrophic neurotoxicity if it is used instead of normal saline in the loss of resistance syringe.
• We strongly advise you apply the prep and allow it to dry as a separate procedure to the epidural itself to avoid any inadvertent errors.


Epidural observations from test dose = refer to local guidelines.
As an example:
• Continuous CTG, observe for LAST (local anaesthetic systemic toxicity) throughout
• 5 minutely foetal heart rate, maternal heart rate, SpO2 & BP for first 30 minutes then 30 minutely until birth
• Sedation score, respiratory rate,
• Sensory and motor block assessment at 30 minutes then hourly until birth’

NOTE:
• BP should remain stable after test test.
• Ensure BP is kept within 10% of baseline as placental blood flow is not autoregulated



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Disclaimer:

The information contained in this video/audio/graphic is for medical practitioner education only. It is not and will not be relevant for the general public.

Where applicable patients have given written informed consent to the use of their images in video/photography and aware that it will be published online and visible by medical practitioners and the general public.

This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such.
The medical information is provided “as is” without any representations or warranties, express or implied.
The presenter makes no representations or warranties in relation to the medical information on this video.
You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant.
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