Dr. David Maclean is the OB Anesthesia Rotation Coordinator. Please contact him with any questions. For any vacation and time off during the rotation, you should also let Dr. Devin Singh, our site Residents Co-ordinator, know after you have received approval from Dr. Maclean.
First Day
For security reasons, it is important to register with Medical Education and obtain a current Sunnybrook ID badge with appropriate identification. This should be done before the start of the rotation.
General Duties / Rounds
Change over time is 07:30 in the morning and 15:45 in the evening during the week days, and 07:45 and 17:45 during the week-end or statutory holidays.
At change over, receive report about labouring patients, scheduled C-sections and any known clinical problems eg accidental dural puncture, patients followed by APS etc.
Team Huddle (OB, Nursing Team Leader, BURT, Anesthesia):
7:45 weekdays for 8 am starts
8:45 Fridays for 9 am starts
9 am - weekend/holidays
Clinical Activities
Labour epidural for analgesia
Elective Cesarean sections (weekdays) - Cesarean sections are listed (highlighted in yellow) in the induction book at the nursing station. Normally these are booked for 0800, 10:30, 13:00 and/or 14:30 (times may vary). Patients are admitted to Triage where nurse will start the IV, usually #18.
Ob Anesthesia Consult clinic - Wednesday afternoons; expect to attend once
Peripartum inpatient consultation for patients located on M5. For complicated cases, case conferences will be arranged.
Analgesic services for terminations/fetal demise.
Cervical cerclage
Obstetric Codes:
Code 33—This refers to a life-threatening situation (maternal or fetal) requiring immediate delivery. The code gives the location (usually an OB operating room but could be a labour room or other location. The team includes OB, anesthesia, BURT (Birthing Unit RT), and pediatrics.
Code Transfusion (Obstetrical)—This refers to severe peripartum bleeding. The code includes the above team + notification of the blood bank, portering, and other services. Standard blood product packs will be provided until the code is discontinued.
The Labour Floor (aka Birthing Unit) M5
There are 20 labour rooms located around the perimeter of east end of M5. Each room has a Laerdal bag, maternal and neonatal oxygen and suction. Epidural carts with Epidural/CSE kits, drugs & emergency equipment are located in the nursing station. An epidural cart will be brought by the nurse to the labour room upon request for epidural placement. Ensure there is an epidural infusion pump & key, and the needed chart information before initiating neuraxial analgesia.
The Operating Room suite consists of 3 operating room, (one standard OR (OR “A”) , one for infectious patients (OR “B”) and one for multiple gestations (OR “C”)), a PACU, and an admission room for the neonates adjoining OR A & C.
HRO (High Risk Obstetrics) inpatients: M5
MNU (Maternal Newborn Unit): M5
Consultation Clinic: M4
Call Rooms: M5127D
Local Anesthetics / Opioids For Epidural Infusion
Premixed infusions for epidural use
0.08% bupivacaine with 2µg/ml Fentanyl cassettes are located in the dispensers near the nursing station and OR core. Access credentials to these dispensers will be arranged upon the beginning of the rotation. Tubing for CADD pumps is available in each epidural cart.
Preprinted orders are available for PCEA. Rate of infusion, PCA bolus dose and lockout time need to be filled in. Options for Programmed Intermittent Epidural Bolus (PIEB) are also available. Ondansetron or other drugs for side effects management can also be ordered as appropriate.
Latex
All equipment on the labour floor is latex-free. However, cassettes for epidural infusion do contain Latex. For patients with history of Latex anaphylaxis, please obtain Latex free cassette from Pharmacy. Note that starting August 9, 2024, all bupivacaine 0.08% with fentanyl 2 mcg/mL will be manufactured LATEX-FREE.
Documentation
All chartings are to be completed on our EMR system, iPro. See here for any iPro related FAQs / issues.
Preprinted neuraxial morphine order forms are filled out for post C-section care.
Difficult airway cart. Includes disposable fiberoptic scope and other aids to endotracheal intubation. Jet ventilation (attached to an “E” O2 cylinder) is available.
Each operating room has standard laryngoscope blades, videolaryngoscopes (glidescope) , bougies, and LMA’s.
Peripartum Hemorrhage cart
Each operating room has a level 1 blood warmer and infuser. Drugs that require refrigeration are kept in PPH Kit boxes in the refrigerator near PACU.
Operating Rooms
Anesthetic cart: (List of contents on side of cart)
Top Bins: syringes, needles, blood tubes, etc.
1st Drawer—Routine drugs identical to the carts in the Main ORs
2nd Drawer—OB specific Drugs. These should include oxytocin, heavy bupivacaine, etc
Check the anesthetic equipment in ORs A, B and C at the beginning of each shift and before the start of each case. Set up the room again immediately after each case. In each rooms, a functioning laryngoscope with short handle, a size 7 (and 6) endotracheal tubes over a stylet should be prepared. Propofol and Succinylcholine (vials only) with syringes ready. All drugs and infusions should be labeled with the time and date and should be used or discarded and replaced every 24 hours. Please see below on how to prepare your daily emergency drugs (courtesy to Dr. Massouh, Faraj)
Conditions necessitating procedure/presence in OR A, B or C
Cesarean sections (elective/urgent/emergent)
Breech deliveries
Manual cephalic version of breech presentation
Multiple gestation deliveries
Removal of retained placenta under anesthesia
Difficult forceps delivery
Severe fetal distress
Other surgical cases e.g. cervical cerclage
Academic Rounds
Department Grand Rounds will take place in the Anesthesia conference room (M3) every Friday 7:30-8:30 am between September and June. For other residents teaching rounds (0700-0730), topics / dates are posted outside the conference room.
Helps
Staff person carries in-house mobile phone (85167)
Problems with anesthetic machine: Page Birthing Unit RT (BURT) 24/7
Anesthesia assistants are available during daytime hours (mobile phone 6290)
Main OR on-call staff mobile phone (7878)
M5 Anesthesia Lounge
Room M5 318D near L&D Triage, access with your badge.
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