LSCS (Under General Anaesthesia)

• 3-way octopus to cannula (Fluid + Phenylephrine infusion + Spare port)
• Pre-oxygenation during catheterisation + surgical preparation
• DAS Obstetric Guidelines
• Antibiotics as per trust polict

• RSI
• Videolaryngoscopy
• Optimise position - Oxford / HELP pillow + Left lateral tilt
• Propofol ( 200-250mg )
• Rocuronium ( 1.2mg/kg )
• Airway
  ETT

Maintenance

• Sevoflurane ( MAC 1.2 ) or Propofol ( titrate to BIS )

Infusions

• phenylephrine ( Titrate to effect )

Antibiotics

• Cefuroxime ( 1.5g )
• Metronidazole ( 500mg )

Uterotonics (Check contraindications)

• Carbetocin ( 100mcg ) or Oxytocin ( 5 IU )
• Once baby delivered + cord clamped

Analgesia

• Paracetamol ( 1g )
• Diclofenac ( 100mg, PR )

Anti-emetics

• ondansetron ( 4mg )

Additional If Required

Uterotonics

• ergometrine ( 500mcg, IM ) - Avoid in pre-eclampsia / hypertension
• carboprost / Hemabate ( 250mcg, IM ) - Avoid in asthma
• misoprostol ( 4 x 200mcg, PR )

Other

• Tranexamic acid ( 1g )

Consider local anaesthetic infiltration / TAP blocks by surgical team

• Procedure NMB Assessment
• Sugammadex
• Awake extubation

Prescriptions

• Paracetamol ( 1g, QDS )
• Ibuprofen ( 400mg, TDS )
• Dihydrocodeine ( 30mg, QDS )
• Dihydrocodeine ( 30mg, QDS PRN )
• Morphine ( PO, PRN )
• Ondansetron ( 4mg )
• Laxative
• LMWH 6 hours post-op
• TEDS
• Fluids

1. Pfannenstiel / Joel-Cohen incision (transverse lower abdomen)
2. Dissection through skin, fascia, rectus sheath, rectus muscle, peritoneum -> to reveal uterus
3. Bladder retraction
4. Uterine incision
5. Fundal pressure from assistant
6. Delivery (+/- delayed cord clamping)
7. Placental delivery (controlled cord traction)
8. Closure of uterine cavity (2 layers), rectus sheath, skin

• Labour Pains