Obstetric Case Set-Up
This a standard OB room setup. Provider preferences may vary. This is simply a guide should be followed with your due diligence of doses and medications. Studentcrna.com is not responsible for errors due to these guides. 
Regardless of the type of anesthesia planned, be sure to set up for general as well. Prepare for possibly difficult airway, unsuccessful neuraxial anesthesia, hemorrhage, and hemodynamic instability.​​
Perform an anesthesia machine. Turn on Etco2 machine and BIS (if used). 
Set up
  • Laryngoscopes (2), Mac and Miller blade (1 each). Make sure laryngoscope light is functional. Have Glidescope or other preferred difficult airway equipment in room.
  • Airway Bougie
  • Eye tape
  • Tongue blade
  • Oral airway (appropriate size)
  • Endotracheal tube- Size 6.5 and 7.0. SMALLER TUBE NEEDED.
  • ETT Stylet
  • Endotracheal tape
  • 10ml syringe for Endotracheal tube. Check tube cuff for leaks
  • Skin/Esophageal temperature probe.

Additional equipment
  • Laryngeal Mask Airway - High risk Difficult airway
  • Nasogastric/Orogastric tube - High risk of Aspiration
  • Rapid infuser - Risk of Hemorrhage
  • Fluid Warmer - Rapid Fluid Administration related Hypothermia
  • Central line Kit (Ultrasound if needed)- Risk of Amniotic Air Embolism
  • Surgical lube
  • BIS monitor
  • Esophageal Temperature probe
  • Bair hugger (lower and upper)
  • Head rest
  • V lead EKG cord
  • Arm straps, padding
  • IV start kits (Large Bore)
  • Set up syringes for the day. Include 30ml, 10ml, 5ml and 3ml
  • Draw and dilute emergency drugs (check vial concentration)

Emergency Medications
Succinylcholine 20mg/ml = 5ml = 100mg

Ephedrine 5mg/ml (Review " General set up " on dilution instructions)
  • Indication: Hypotension with Bradycardia
  • Class: Synthetic, Non Selective Symphathomimetic drug
  • Action: Direct Beta stimulation and indirect alpha stimulation causes release of endogenous norepinephrine.
  • Onset: Quick Duration: 5 minutes
  • Metabolism: Liver; 40% excreted unchanged in Kidneys.
  • Risks: Tachyphylaxis, fetal acidosis

Phenylephrine 100mcg/ml (Review " General set up " on dilution instructions)
  • Indication: Hypotension with Tachycardia
  • Class: Alpha 1 agonist
  • Action: Peripheral vasoconstriction
  • Onset: Quick
  • Metabolism: MAO and sulfotransferase enzymes in enterocytes and liver

Standard Induction Medication:
  • Fentanyl- Preferred in OB- High potency, short duration, in Fetal circulation in 1 minute
  • Propofol (other Hypnotics)
  • Succinylcholine- for RSI
  • Non Depolarizing muscle relaxant.
  
Obstetric Physiologic changes
  • Dilutional anemia
  • Increased minute ventilation due to increase in VT
  • Increased CO. Highest immediately post delivery up to 180%.
  • Displaced gastrointestinal system. Increased risk of aspiration. Increase in acid volume.
  • Difficult airway. Narrowing of glottic opening, generalized edema, capillary engorgement.

Obstetric Pharmacology
Pitocin (Oxytocin) 20u - 40 u in 1000ml LR over 15-20 minutes
  • Indication: Uterine Atony, immediate post delivery
  • Class: Endogenous Hormone produced by posterior pituitary gland
  • Action: Lowers threshold for depolarization in uterine smooth muscle
  • Risks: Vasodilation, Tachycardia

Methergine (Ergotrate)- 0.2mg IM dose
  • Indication: Secondary to Pitocin Uterine atony.
  • Class: Ergot Alkaloids
  • Action: Agonist effects on the alpha adrenergic receptors
  • Onset: 1-2 minute, Repeated in 15-20minutes to a total of 0.8mg
  • Risks: Profound Hypertension
  • DO NOT USE IN: Eclampsia (or Pre), chronic hypertension, ischemic heart disease, peripheral vascular disease.

Hemabate (Methylprostaglandin) - 250mcg IM or IU
  • Indication: Secondary to Methergine, contraindication to Methergine. Uterine atony
  • Class: Synthetic Prostaglandin
  • Action: Increased myometrium calcium levels causing increase in myosin light chain kinase activity resulting in uterine contraction
  • Risks: Bronchospasm, VQ mismatch
  • DO NOT USE IN: Asthmatics, reactive airway disease, pulm. HTN
  • Alternative: Misoprostol (for asthmatics, pulm. HTN)

Nitroglycerin - 2oo-400 mcg IV Dose
  • Uses: Uterine relaxation in external version, fetal head entrapment, extraction of second twin, retained placenta, or uterine inversion.
  • Action: Uterine and cervical relaxation via nitric oxide
  • Quick, profound uterine relaxation
  • Risks: Hypotension