Stat C/S

Epidural Extension

Converting labor epidural to surgical anesthesia

1
Phase 1

Educate & Reassure

Patient preparation and informed consent

Action Steps

Explain procedure clearly to patient
Explain risks: failed/high block, difficult airway
Obtain informed consent for procedure
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2
Phase 2

Prepare & Check

Pre-procedure assessment and setup

Action Steps

Aspiration prophylaxis if high risk (obesity, diabetes, recent intake, earlier risk)
Secure adequate IV access
Check epidural patency (sensory level, last bolus time/dose)
Inspect catheter for migration
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3
Phase 3

Bolus & Transfer

Labor room dosing and patient transport

Action Steps

Epidural bolus: 4 mL of 2% chloroprocaine or 2% Lidocaine + epi
Transfer to OR with left uterine displacement
Monitor high block during transfer
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4
Phase 4

Assess & Top-Up

Operating room block optimization

Action Steps

Apply monitors
Assess sensory + motor block
Confirm bilateral, dense, cephalad spread
Additional dosing up to 15-20 mL total
Adjuvants: fentanyl 50-100 mcg; morphine 3-4 mg
Adjuvants: epinephrine 1:200,000; sodium bicarbonate 1 mEq per 10 mL LA
Target level: T6 (loss of touch) or T4 (loss of sharp)
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5
Phase 5

Start Surgery & Maintain Block

Surgical clearance and ongoing management

Action Steps

Allow incision once target level achieved
Maintain block with:
Additional LA bolus: 4-7 mL at ~20 min
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