Frequently asked questions

The responses below are among the most frequently asked queries to the “Ask SOAP a question” site. These responses were last updated in August 2007. Please review these responses; if you still have a question, please see the link at the bottom of the page.
 

FAQ 1: Intra-Operative Fetal Monitoring

Are there guidelines for intra-operative fetal monitoring during non-obstetric surgery in pregnant patients? 
 

SOAP does not have guidelines for pregnant patients undergoing non-obstetric surgery but the ACOG Committee Opinion on "Non-obstetric Surgery in Pregnancy" (ACOG Committee Opinion Number 284: Non-obstetric surgery in pregnancy. Obstet Gynecol. 2003;102:431.)  states in part that "Although there are no data to support specific recommendations regarding non-obstetric surgery and anesthesia in pregnancy, it is important for non-obstetric physicians to obtain obstetric consultation before performing non-obstetric surgery. The decision to use fetal monitoring should be individualized, and, if used, may be based on gestational age, type of surgery, and facilities available.  Each case warrants a team approach for optimal safety of the woman and her baby."  If it does not interfere with the surgical field, intermittent or continuous fetal monitoring can be utilized to ensure that the intrauterine environment is optimized. Fetal heart tones can be checked before and after the surgery or continuous monitoring may be attempted throughout the case. 

 

FAQ 2: National Labor Analgesia Rates

What are the most recently published national labor epidural rates? 
 

The most recent Obstetric Anesthesia Workforce Survey has the most current data: Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA. Obstetric anesthesia workforce survey: twenty-year update.  Anesthesiology. 2005 Sep;103(3):645-53.  This is available as a free full text

 

FAQ’s 3 and 4: Anesthesiologist’s Availability on Labor and Delivery

What is SOAP’s position on the anesthesiologist remaining in the hospital after placing a labor epidural? 
 

Are there any billing issues or standard of care issues that would prevent a solo provider  from going home after placing a labor epidural? 
 

SOAP does not have an official position on anesthesiologists remaining in the hospital following the placement of a labor epidural technique, however guidance on this topic can be found in The ASA Optimal Goals for Anesthesia Care in Obstetrics. This document can be found:

http://www.asahq.org/publicationsAndServices/standards24.html.   SOAP agrees with these goals.  Moreover, helpful information about the practice of obstetric anesthesia can be found at the American Society of Anesthesiologists general website: http://www.asahq.org.   

Your state society of anesthesiologists may be able to assist with Medicare billing or standards of care, which vary from state to state.  In addition, contacting other anesthesia groups within your state with similar practices may be helpful.

 

FAQ 5: PCA Labor Analgesia

Please provide information (e.g. dosage, recommendations) about patient controlled analgesia (PCA) Fentanyl  for labor pain control. 
 

A number of different regimens exist for patient controlled analgesia (PCA) (e.g. opioids, settings), with no commonly accepted “standard”. The following reference may be helpful:

Campbell DC. Parenteral opioids for labor analgesia.  Clin Obstet Gynecol. 2003;46:616-22.  


 

FAQ 6: Patient-Controlled  Epidural  Analgesia (PCEA)

My current group seems quite resistant to the idea of PCEA for labor.  What is SOAP’s recommendation? 
 

The most recent ASA Practice Guidelines for Obstetric Anesthesia (http://www.ASAhq.org/publicationsAndServices/practiceparam.htm#ob) state that PCEA may be used to provide an effective and flexible approach for the maintenance of labor analgesia.  The Task Force notes that the use of PCEA may be preferable to continuous infusions for providing fewer anesthetic interventions and reduced dosages of local anesthetics than fixed-rate continuous epidural infusions.  PCEA may be used with or without a background infusion.   
 

The following references may be helpful:

1. Halpern S. Recent advances in patient-controlled epidural analgesia for labour. Curr Opin Anaesthesiol 2005;18:247-51.2.

2. Paech M. Newer techniques of labor analgesia. Anesthesiol Clin North America 2003;21:1-17.

3. D'Angelo R. New techniques for labor analgesia: PCEA and CSE. Clin Obstet Gynecol 2003;46:623-32. 
   
   
    

FAQ 7: Anesthesia for Postpartum Tubal Sterilization

Is there a recommendation from SOAP regarding the use of general anesthesia in post-partum patients who desire sterilization when regional anesthesia is refused or contraindicated? 
 

The most recent ASA Practice Guidelines for Obstetric Anesthesia are a good reference:

http://www.ASAhq.org/publicationsAndServices/practiceparam.htm#ob 
 
Recommendations.  For postpartum tubal ligation, the patient should have no oral intake of solid foods within 6 to 8 hours of the surgery, depending on the type of food ingested (e.g., fat content). Aspiration prophylaxis should be considered.  Both the timing of the procedure and the decision to use a particular anesthetic technique (i.e., neuraxial versus general) should be individualized, based on anesthetic risk factors, obstetric risk factors (e.g., blood loss), and patient preferences.  However, neuraxial techniques are preferred to general anesthesia for most postpartum tubal ligations.  The anesthesiologist should be aware that gastric emptying will be delayed in patients who have received opioids during labor, and that an epidural catheter placed for labor may be more likely to fail with longer post-delivery time intervals.  If a postpartum tubal ligation is to be performed before the patient is discharged from the hospital, the procedure should not be attempted at a time when it might compromise other aspects of patient care on the labor and delivery unit. 
 

FAQ 8: Platelet Counts and Epidural Placement

Is a platelet count considered a standard of care before routine neuraxial analgesia for labor? 
 

To answer the question about obtaining platelet counts prior to neuraxial analgesics in laboring patients, the ASA Practice Guidelines for Obstetric Anesthesia are a good resource and can be found at the following website:

http://www.asahq.org/publicationsAndServices/practiceparam.htm#ob 
 

Recommendations. A specific platelet count predictive of neuraxial anesthetic complications has not been determined. The anesthesiologist’s decision to order or require a platelet count should be individualized and based on a patient’s history, physical examination, and clinical signs. A routine platelet count is not necessary in the healthy parturient. 


 

FAQ 9:  NPO Status and the Parturient

What are the current recommendations for NPO status in obstetric patients? 
 

The ASA Practice Guidelines for Obstetric Anesthesia

(http://www.asahq.org/publicationsAndServices/practiceparam.htm#ob) refer to NPO status prior to surgical procedures, and to the allowability of clear liquid intake during labor with an epidural. There is no requirement for any NPO time for either liquids or solids prior to epidural analgesia in the laboring patient. 
 

The ASA Practice Guidelines for Obstetric Anesthesia provide the following recommendations:

Solid foods should be avoided in laboring patients. The patient undergoing elective surgery (e.g., scheduled cesarean delivery or postpartum tubal ligation) should undergo a fasting period for solids of 6–8 h depending on the type of food ingested (e.g., fat content). The uncomplicated patient undergoing elective cesarean delivery may have modest amounts of clear liquids up to 2 h before induction of anesthesia. Examples of clear liquids include, but are not limited to, water, fruit juices without pulp, carbonated beverages, clear tea, black coffee, and sports drinks. 


 

FAQ 10:  Fluid Preloading and Epidural Analgesia

Does SOAP have a recommendation or written guideline for fluid preloading prior to labor epidural placement? 
 

The most recent ASA Practice Guidelines for Obstetric Anesthesia (http://www.asahq.org/publicationsAndServices/practiceparam.htm#ob) are a good resource.  The Guidelines state: "An intravenous infusion should be established before the initiation of neuraxial analgesia or anesthesia and maintained throughout the duration of the neuraxial analgesic or anesthetic.  However, administration of a fixed volume of intravenous fluid is not required before neuraxial analgesia is initiated.” 
 

FAQ 11: AWHONN Position Statement

Does SOAP have a position statement on the management of labor epidural pumps by labor and delivery  nurses? 
 

The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) has specific guidelines that can be found at the following website:

www.awhonn.org/awhonn/?pg=873-6230-7000-4730-4760. 
 

The ASA "Statement on the Role of Registered nurses in the Management of Continuous Regional Anesthesia" may also be helpful and can be found at:

http://www.asahq.org/publicationsAndServices/sgstoc.htm 


 

FAQ 12:  Neuraxial Analgesia in the Parturient with Fetal Demise

Does SOAP have recommendations for labor epidural placement in parturients with an intrauterine fetal demise? 

SOAP does not have specific guidelines. Please refer to the following reference: Maslow AD, Breen TW, et. al. Prevalence of coagulation abnormalities associated with intrauterine fetal death. Can J Anaesth. 1996; 43:1237-43.

Additional information about platelet counts can be found in the ASA Practice Guidelines for Obstetric Anesthesia:

http://www.asahq.org/publicationsAndServices/practiceparam.htm#ob

FAQ 13:  Aseptic Technique and Neuraxial Infection

Are there guidelines for aseptic technique during epidural catheter insertion? 
 

The most recent Special Article published in Regional Anesthesia and Pain Medicine is a good reference: : Hebl JR. The importance and implications of aseptic techniques during regional anesthesia. Reg Anesth Pain Med. 2006 Jul-Aug;31(4):311-23.  


 

FAQ 14:  Anticoagulants  and Neuraxial Anesthesia/Analgesia

Is there a SOAP consensus statement/policy on the use of regional anesthesia for patients receiving anticoagulants?  
 

SOAP does not have a consensus statement or policy regarding the use of regional anesthesia for patients receiving anticoagulants.  However, two helpful resources are: 

1.  The American Society of Regional Anesthesia (ASRA) consensus statement (http://www.asra.com/consensus-statements/2.html) for the administration of neuraxial anesthesia in patients receiving anticoagulants.

2.  the American College of Obstetricians and Gynecologists (ACOG) has a Committee Opinion on Lovenox administration during pregnancy. American College of Obstetricians and Gynecologists.  ACOG Committee Opinion: safety of Lovenox in pregnancy. Obstet Gynecol. 2002 Oct;100(4):845-6.   

Do you still have a question that you would like to ask?

Then click here to "Ask SOAP a Question"

The Society for Obstetric Anesthesia and Perinatology (SOAP) provides this website as a service and an educational resource for its members and the public. SOAP, any website contributors and their affiliates do not make any warranties or representations as to the accuracy, adequacy or completeness of any information presented here, which is provided on an "as is" basis. While all reasonable attempts are made to insure the correctness and suitability of information provided on this website and corrections are periodically made to correct errors brought to our attention, no guarantee can be made as to the correctness or suitability of such information or any other linked information presented, referenced or implied.