Obstetric Anesthesia
Goals and Objectives
CA 3 Level
Definition
During the CA-3 year, Obstetric Anesthesia may be selected as a one month, or more, elective rotation.
Curriculum
All residents rotating through the service are expected to gain an understanding of basic principles of both clinical and cognitive management of peripartum anesthetic needs. Development of competence in pre-anesthetic assessment and planning, intra-partum management, rational responses to and prevention of complications and post-anesthetic care appropriate to the parturient in a community or tertiary care hospital are expected. CA-3 residents will attain additional experience in these areas, allowing them to assist in the training of junior residents and act with increasing autonomy in the care of normal and high risk parturients.
Medical Knowledge
At the conclusion of this rotation, the resident should be able to describe:
1. Describe the pathophysiology and anesthetic management of common clinical conditions producing high risk pregnancy, (e.g. preeclampsia, placental abnormalities, diabetes, obesity)
2. Identify and describe the management of embolic disorders, including amniotic, thrombotic, and air.
3. Understand the anesthetic management of parturients with co-existing medical diseases such as disorders of the cardiac, respiratory, neurologic and neuromuscular, hematologic and coagulation systems.
4. Describe the basic principles and rationale of fetal assessment including oxytocin challenge testing, non-stress tests, biophysical profiles, and fetal monitoring.
5. Describe the basic principles and sequencing of neonatal evaluation and resuscitation.
6. Identify and describe the management of the difficult airway in the parturient.
7. Discuss the implications and describe the management of non-obstetric surgery in pregnancy.
8. Describe the management of cardiac arrest in the pregnant patient.
Patient Care
At the conclusion of this rotation, the resident should be able to:
1. Identify parturients who will benefit from anesthesia evaluation during labor.
2. Correctly identify analgesia options for labor.
3. Be responsible for formulating an anesthetic management plan for the majority of patients. Demonstrate the ability to develop and discuss this plan with obstetric colleagues.
4. Place a lumbar epidural catheter for analgesia with minimal assistance in the majority (90%) of cases.
5. Correctly connect an epidural catheter to an infusion pump and provide continuous analgesia.
6. Prepare an obstetric operating room for emergency cesarean delivery.
7. Place a subarachnoid block with minimal assistance for elective or repeat cesarean delivery in the majority of cases.
8. Perform rapid sequence induction with minimal faculty assistance for maternal/fetal emergency.
9. Demonstrate leadership and crisis management skills in emergent situations.
10. Provide analgesia/anesthesia for removal of retained placental fragments with minimal faculty assistance.
11. Correctly recognize and respond to unplanned dural puncture during epidural placement.
12. Diagnose post-dural puncture headache (PDPH).
13. Prescribe conservative management for PDPH.
14. Perform an epidural blood patch with minimal assistance in the majority of cases for PDPH.
15. Provide anesthesia for cervical cerclage.
16. Provide anesthesia for an assisted second stage vaginal delivery.
17. Provide anesthesia for post-partum tubal ligation.
18. Recognize and respond to obstetric hemorrhage.
19. Perform (or describe how to perform) neonatal resuscitation.
20. Provide analgesia / anesthesia for an external cephalic version, based on the patient’s need for delivery following the procedure.
Professionalism
At the conclusion of this rotation, the resident must:
1. Adhere to procedures designed for maternal privacy and security of the newborn.
2. Demonstrate the ability to achieve pain relief in a parturient with severe pain.
3. Communicate with all levels of professionals working to provide obstetric care, including physicians, midwives, and RNs.
4. Provide consultation services for complicated obstetric patients.
5. Confirm effective analgesia after cesarean delivery
Systems-Based Practice
At the conclusion of this rotation, the resident must:
- Be able to participate in daily morning report and weekly Team Meeting where systems issues on L&D are discussed with nursing and obstetric care providers (MD and CNM).
- Participate in care conferences on high risk patients in preparation for their delivery.
- Participate in at least one postpartum hemorrhage simulation with the nursing and OB services for team training.
- Attend High Risk OB clinic once a week to interact on patients who may need specialized anesthesia services at delivery.
Rev. 7/2009
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