Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Epidural anaesthesia and analgesiaPatients who are nil by mouth may have rectal preparations as longas this has been authorised by the consultant responsible. The rectalroute should only be used until patients are able to take oralanalgesics.Ward based epiduralsA ward based epidural service has been established on theenhanced care unit on ward 22. The lead consultant anaesthetist isDr Krish Ramachandran; Sister Sue Millerchip of the painmanagement service is the lead nurse.Suitable patients following either colorectal, vascular or uppergastrointestinal surgery with epidural analgesia may be transferredeither directly from theatre recovery or following a period ofassessment in general critical care.The anaesthetist involved with the case will have responsibility formaking sure the epidural is working. The pain team will also beassessing these patients whilst in PACU. All patients who areconsidered fit to go back to the ward (level 1) will be monitored inPACU for between two and four hours. Once stable they will betransferred to the ward (see below). Once discharged to the ward thepain team and the resident anaesthetists will be responsible forfollowing up these patients. In particular, the anaesthesia residentsare responsible for dealing with incidents and problems out of hours.There is a clinical guideline covering ward based epidurals which willshortly be reviewed and updated. It is the responsibility of the wardnursing and medical staff to call the resident anaesthetists to attendat various appropriate points. If you are busy you must let the wardknow approximately when you will be able to attend, along with anyadvice on the problem.In particular, the ward staff must not leave hypotensionuntreated while awaiting an anaesthetist.140 Anaesthetists Handbook January 2010