Emergency CS Epidural Top-Up — FRCA Final MCQ

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ModerateObstetric AnaesthesiaEmergency CS Epidural Top-UpFRCA Final

Working epidural at T10 bilaterally. Category 1 CS needed. Fastest way to convert to surgical anaesthesia?

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Correct answer: C — Top up 15-20 mL 2% lidocaine with 1:200,000 adrenaline

2% lidocaine + adrenaline = fastest epidural agent (5-10 min to T4). Give 15-20 mL in 5 mL increments. Add epidural fentanyl 100 mcg + NaHCO3 (1 mL/10 mL LA) to accelerate onset. 0.5% bupivacaine is slower (15-20 min).

Reference: OAA/AAGBI – 2023 – Emergency CS guidelines