Category 1 Caesarean Section in IV Substance User

You are the anaesthetist on site at a tertiary obstetric hospital. The obstetric registrar has called a category 1 lower uterine segment caesarean section (LSCS) for a 35-year-old woman, G6P5, at 31+6 weeks gestation, who presented to the hospital with possible decreased fetal movements. The patient has not had any antenatal care during the pregnancy. She has a known intravenous substance user disorder with polysubstance use. Obstetric History 3 previous LSCS (one with general anaesthesia, two with neuraxial anaesthesia) 2 spontaneous vaginal deliveries Medical History Current smoker, 10-pack-year history Asthma since childhood Medications Suboxone (buprenorphine/naloxone) 12 mg once daily Observations HR 85 bpm BP 100/80 mmHg SpO2 96% on room air