Chapter 37: Anesthesia Consultation

PURPOSE

Recognition of significant risks for anesthetic or obstetric complications should encourage an anesthesia consult.¹ The consultation allows for advance planning and preparation; helps to determine what additional tests, consults, or treatment should be obtained; and facilitates early and ongoing multidisciplinary communication, if indicated. Antepartum obstetric anesthesia consults should be obtained after fetal viability, but early enough in gestation to allow for scheduling of appropriate diagnostic tests (generally between 24- and 34-weeks’ gestation). The availability of bedside point-of-care ultrasound can aid in patient counseling (e.g., neuraxial ultrasound for scoliosis or high body mass index [BMI]).

REASONS TO REQUEST AN ANESTHESIA CONSULT

Reasons to Request an Anesthesia Consult²

• Pre-pregnancy BMI >45 or current weight over 300 lbs

• Severe facial and neck edema or malformation

• Extremely short stature

• Abnormally short neck (or after a surgery with fusion of the neck)

• Difficulty opening the mouth

• Large thyroid

• Severe asthma

• Serious medical or obstetrical complications, including, but not limited to, medical conditions such as:

  • Cardiac (e.g., valvular stenosis or moderate to severe regurgitation, significant arrhythmia, cardiomyopathy)

  • Pulmonary, including severe asthma

  • Neurologic

  • Hematologic

  • Spine (history of spinal surgery, significant scoliosis, or unstable lumbar pain syndrome)

  • Any other significant problem that the obstetrician or patient believes could negatively impact the safe or effective administration of anesthesia for delivery

• History of complications with anesthetics

• History of chronic use of prescription pain medicines or buprenorphine (subutex or suboxone) prior or during pregnancy

• Current use of anticoagulant medications

Consultation for inpatients may be considered with:

• Pregnancy-associated hypertensive disorders (preeclampsia with severe features, HELLP [hemolysis, elevated liver enzymes, and low platelets] syndrome)

• Placental abruption

• Placenta previa

• Abnormal placentation (accreta, increta, percreta)

• Platelet count less than 100,000/mm³

• Plan for nonobstetric surgery during pregnancy

• Serious conditions that may necessitate emergency cesarean delivery

HOW TO OBTAIN AN ANESTHESIA CONSULT

Call extension 123-456-7890 to leave a message (24/7). Or you can email AnesthesiaOBConsults@yourinstitute.edu

The following information is needed:

• Patient name, medical record number, and contact information

• Obstetrician’s name and contact information

• Indication for consult

• Estimated delivery date

• Whether interpreter is necessary

An anesthesiologist (a senior resident or fellow, with an attending physician) will see the patient on Labor and Delivery Unit for the consult, or on the antepartum floor if the patient is currently admitted.

• There is no fee for this consult.

• The anesthesiologist will write a note in the online medical record and forward this note to the obstetrician. If needed, further communication with the obstetrician of any additional tests, consults, therapies will be made.

REFERENCES