Guidelines to the practice of anaesthesia, as recommended by the Canadian Anaesthetists' Society, 1993 edition*
Experience since publication of the guidelines in the September 1986 issue of the CAS Newsletter has shown that the incidence of major complications associated with continuous low-dose epidural infusion for obstetrical analgesia is extremely low.
Consequently, it is not necessary for the anaesthetist to remain physically present or be immediately available during maintenance of continuous infusion epidural analgesia provided:
- an appropriate protocol for the management of these epidurals is in place;
- an anaesthetist can be contacted for the purposes of giving advice and direction.
In contrast to continuous infusion epidural analgesia, bolus injection of local anaesthetic into the epidural space can be associated with immediate life-threatening complications. In recognition of this, the CAS recommends that:
- When a bolus dose of local anaesthetic is injected into the epidural space, an anaesthetist must be available to intervene appropriately should any complications arise.
- The intent of the phrase "available to intervene appropriately" is that individual departments of anaesthesia shall make their own determination with regard to availability and appropriateness. This determination must be made after each individual department of anaesthesia has considered the possible risks of bolus injection of local anaesthetic and also methods of dealing with any emergency situation that might arise from the performance of the procedure in their facility.
*Reproduced with the permission of the Canadian Anaesthetists' Society.[9]
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