1
Team Alignment
Ensure all roles are available
Obstetrician
Anesthesiologist
Nursing Staff
Neonatal Team
2
Assess & Consent
Airway, aspiration, hemorrhage
3
Prepare
RSI drugs, airway, suction, vasopressors
4
Position
Supine + left uterine displacement
5
IV/Labs
>=18G IV, labs and type & cross
6
Aspiration Prophylaxis
Administer immediately
Sodium Citrate
Dose
30ml
Ranitidine
Dose
50mg
Metoclopramide
Dose
10mg
7
Antibiotics
within 60 min before incision
8
Monitors + Time-Out
Verify patient/procedure/equipment
9
Preoxygenation
100% O2 for >=3 min (or 4-8 VC breaths)
3:00
10
RSI
Rapid Sequence Induction
Cricoid Pressure
Awake: 10 N
After LOC: 30 N
Standard
Propofol
Dose
2-2.8 mg/kg
Alternative
Ketamine
Use in hypotension/asthma; avoid in HTN/pre-e
Dose
1-1.5 mg/kg
Alternative
Etomidate
Use in unstable/cardiac disease
Dose
0.3 mg/kg
Paralytic
Succinylcholine
Fastest onset
Dose
1-1.5 mg/kg
Alt paralytic
Rocuronium
If SCh contraindicated
Dose
1 mg/kg
11
Intubate
Confirm ETCO2 + bilateral breath sounds
12
Anesthesia ~1 MAC
Volatile (iso/sevo/des) with O2 +/- N2O (<=50%). No opioids pre-delivery
13
Hemodynamics
Treat hypotension (phenylephrine/ephedrine)
14
Paralysis
Rocuronium as needed (TOF-guided)
15
Delivery Observed
Note time; await cord clamping
16
Uterotonics
Oxytocin bolus/infusion; escalate if poor tone
17
Adjust Depth
Volatile 0.5-0.75 MAC, add opioid +/- N2O
18
Extubate
Awake, following commands
19
Postop
Pain, nausea, bleeding surveillance