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Operative Vaginal Delivery and Perineal Repair

Anesthesia Implications

Clinically reviewed by anesthesia providers · Updated

Position : Lithotomy, arms at side on armboards, left uterine displacement
Time : 30-60 min (short)
Blood Loss : Very High (500+ ml)
Post-op Pain : Moderate (4-6)
Maintenance Paralytic : None for the usual case under neuraxial block; only on conversion to general anesthesia for a category-1 cesarean.
Blocks : Pudendal
Considerations : Pregnancy / Obstetric, Aspiration risk / Full stomach, Neonatal resuscitation / NICU standby, High Blood Loss, PONV

Anesthetic Approaches

1Epidural
2Spinal
3GETT
The Surgery

Deciding the instrument and the place - the obstetrician classifies the attempt by station and rotation, and then makes the single decision that shapes your anesthetic: is this a straightforward...

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