Managing Complications in Pregnancy and Childbirth: - IAWG

Anaesthesia and analgesiaC-43MANAGEMENT OF LIGNOCAINE ALLERGY• Give adrenaline 1:1 000, 0.5 mL IM, repeated every 10 minutes ifnecessary.• In acute situations, give hydrocortisone 100 mg IV every hour.• To prevent recurrence, give diphenhydramine 50 mg IM or IVslowly, then 50 mg by mouth every 6 hours.• Treat bronchospasm with aminophylline 250 mg in normal saline 10mL IV slowly.• Laryngeal oedema may require immediate tracheostomy.• For shock, begin standard shock management (page S-1).• Severe or recurrent signs may require corticosteroids (e.g.hydrocortisone IV 2 mg/kg body weight every 4 hours untilcondition improves). In chronic situations give prednisone 5 mg orprednisolone 10 mg by mouth every 6 hours until conditionimproves.MANAGEMENT OF LIGNOCAINE TOXICITYSymptoms and signs of toxicity (Table C-5, page C-41) should alert thepractitioner to immediately stop injecting and prepare to treat severeand life-threatening side effects. If symptoms and signs of mild toxicityare observed, wait a few minutes to see if the symptoms subside, checkvital signs, talk to the woman and then continue the procedure, ifpossible.CONVULSIONS• Turn the woman to her left side, insert an airway and aspiratesecretions.• Give oxygen at 6–8 L per minute by mask or nasal cannulae.• Give diazepam 1–5 mg IV in 1 mg increments. Repeat if convulsionsrecur.Note: The use of diazepam to treat convulsions may causerespiratory depression.RESPIRATORY ARREST• If the woman is not breathing, assist ventilation using an Ambubag and mask or via endotracheal tube; Give oxygen at 4–6 L perminute.