1 OPTIMAL GOALS FOR ANESTHESIA CARE IN OBSTETRICS

ABSTRACT: This joint statement from the American Society of Anesthesiologists (ASA) and the American College of Obstetricians and Gynecologists (the College) has been designed to address issues of concern to both specialties. Good obstetric care requires the availability of qualified personnel and equipment to administer general or neuraxial anesthesia. The extent and degree to which anesthesia services are available varies widely among hospitals. However, for any hospital providing obstetric care, certain optimal anesthesia goals should be sought. These include: I. Availability of a licensed practitioner who is credentialed to administer an appropriate anesthetic whenever necessary. For many women, neuraxial anesthesia (epidural, spinal, or combined spinal epidural) will be the most appropriate anesthetic. II. Availability of a licensed practitioner who is credentialed to maintain support of vital functions in any obstetric emergency. III. Availability of anesthesia and surgical personnel to permit the start of a cesarean delivery in a timely manner in accordance with clinical needs and local resources. IV. Because the risks associated with trial of labor after cesarean delivery (TOLAC) and uterine rupture may be unpredictable, the immediate availability of appropriate facilities and personnel