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  • 500 mg, diluted in 20 mL of normal saline (NS)/lactated Ringers, infusion slowly over 1 hour.

  • 4 mg of Ondansetron intravenously (IV) before infusion due to significant nausea and vomiting.

  • Indications: intrapartum cesarean section, spontaneous rupture of membrane.

  • Reference: N Engl J Med. 2016;375:1231-1241.


  • Generic name: sodium citrate/citric acid; 30 mL per container.

  • Per os (PO), before epidural placement and before cesarean delivery.


  • 3% chloroprocaine, preservative free (PF).

  • Alkalization: In a 30-mL syringe, add 2 mL of 8.4% bicarbonate to 20 mL of chloroprocaine.

  • Use for emergent cesarean delivery or for forceps delivery.

  • STAT Cesarean Kit: Prepackage in obstetric anesthesia office: (1) 3% chloroprocaine; (1) 8.4% bicarbonate; (1) 30-mL syringe; (1) blunt needle. Replace it after use.


  • Dilute 200 µg in 20 mL of NS, final concentration 10 µg/mL.

  • Indications:

    • Severe shivering after delivery: 10 µg IV, may repeat up to 30 µg.

    • Severe pruritus associated with epidural fentanyl, see Chapter 6.

  • Reference: Int J Obstet Anesth. 2021;45:49-55.


  • Premixed by pharmacy, 5 mg/mL.

  • Historically, ephedrine was used as the “Gold standard” for spinal hypotension.

  • Higher placental transfer than phenylephrine; it can cause clinically insignificant fetal acidosis.

  • Since late 1990s, used as a second-line medicine for maternal hypotension.

  • References: Am J Obstet Gynecol. 1968;102:911.

    • Anesthesiology. 2009;111:506-512.


  • Add 250 µg to 150 mL premixed bupivacaine/fentanyl epidural solution; final concentration will be 1.67 µg/mL.

  • Add 5 µg/mL of epinephrine into 2% lidocaine for cesarean delivery.

  • Mechanisms: alpha-2 synergic effect, alpha-1 vasoconstriction to prolong the duration of anesthesia and decrease systemic absorption.

  • Reference: J Anesth Perioper Med. 2019;6:1-7.


  • 2% lidocaine, PF.

  • Alkalization of lidocaine: in a 30-mL syringe, add 2 mL of 8.4% bicarbonate to 20 mL of lidocaine.

  • For cesarean delivery, add 5 µg/mL of epinephrine.


  • 2 g/h infusion as maintenance dose.

  • For preeclampsia, continue magnesium for entire cesarean delivery.

  • For fetal neuroprotection, discontinue magnesium after delivery.

  • Reference: The Magpie Trial. Lancet. 2002;359:1877-1890.


  • 0.5 mL/mL, PF, pre-made by pharmacy, stored at 4°C.

  • Indications:

    • Cesarean delivery—spinal 250 µg, epidural 3 mg.

    • Labor CSE for dysfunctional labor—spinal 100 µg.

    • After third degree vaginal laceration repair—epidural 2 mg.


  • 400 µg/mL, light sensitive. Kept in Omnicell in the operating room. Dilute to 100 µg/mL.

  • Dose: 100 µg IV, may repeat, titrate to effect.

  • Indications: cervico-uterine relaxation, inverted uterus, difficult extraction at cesarean delivery.

  • Reference: Am J Obstet Gynecol. 1998;179:813.


  • Pre-made by pharmacy, 100 µg/mL.

  • Indications: first-line medication for maternal hypotension.

  • Phenylephrine use is associated with a decrease in maternal cardiac output, but the clinical significance is not clear.

  • Infusion at 0.5 to 0.7 µg/kg/min or bolus 100 µg, titrate to effect.

  • Reference: Anesth Analg. 2012;114:377.


  • 1 mg/mL, use 0.25 mg, subcutaneously, administrated by the nurse.

  • Indications:

    • Tachysystole contraction with associated fetal heart rate changes.

    • Before external cephalic version at obstetrician’s discretion.

  • ACOG Practice ...

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