Crash

The Cesarean section can be done with various anesthetic techniques. A spinal injection into the cerebrospinal fluid will achieve surgical numbness. An epidural catheter can be bolused with local anesthetic to achieve the same effect. Both of these "neuraxial" techniques have the advantages of minimizing drug exposure to the baby and letting the patient see her baby once she delivers.

We only elect general anesthesia in exceptional cases and emergency "crash" sections. Although it is the fastest technique, exposes the baby to medications and involves a challenging airway in an urgent situation. I was called to a stat C-section for fetal distress. Fortunately, we had the room set up for an emergency and my attending was already present. When the patient rolled in, she was terrified, confused, and in pain. It was chaotic; normally, operating rooms are an exemplar of order, but here, people were yelling for assistance or medications or supplies. Although the patient had an epidural in place, bolusing it would take 5 minutes for surgical anesthesia, and we didn't have that much time. I pre-oxygenated, my attending put on monitors, the nurses opened the case cart, and the surgeons scrubbed. When the surgeons were ready to cut, we induced; ten seconds later, I took a look, saw vocal cords, and intubated the trachea. Immediately after that, my attending gave the okay and the surgeons cut. Before I had finished taping the endotracheal tube, the baby was out. I hadn't even given the surgical prophylactic antibiotics; there was no time. All the steps were compressed to minimize risk to the baby and keep the mother as safe as possible. Fortunately, the baby and mother did fine. It was an incredibly stressful moment but in that situation, I felt pretty calm; afterwards, I was trembling. Much of anesthesia is routine, but occasionally, we have to react under extraordinarily stressful and life-determining situations.

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