Dept Of Anesthesiology & Critical Care, University Of Pennsylvania School Of Medicine: Maternal Mortality and Anesthesia
UPenn has a nice blog where they review topics of interest. They have a great summary from a review of maternal mortality involving anesthesia. While this isn’t directly an APM topic, the lessons learned will be of interest. An excerpt:
Epidural Catheters: Eight of these thirteen patients arrested in labor rooms following attempted insertion and dosing of epidural catheters to relieve labor pains. Of these, 7 had subsequent evidence of unintentional subarachnoid blocks. All eight arrests occurred within the first 30 min of initial catheter placement. In four cases the anesthesiologist was not in the room at the time of the arrest. Seven of the 8 cases involved transfer of a mother in respiratory or circulatory arrest from the labor room to the operating room for a STAT section due to fetal distress. In four of these cases there were documented delays in ventilation of the mother for reasons including failure to notice maternal arrest, desire for more optimal intubating conditions present in OR, difficulty locating an Ambu-bag, or anesthesia provider not present. In the one patient who did not have neurologic residual, the patient was placed supine in the delivery room by the anesthesiologist and was ventilated by bag and mask as soon as ventilation appeared inadequate. Blood pressure was supported by i.v. fluids and the caesarian section was done in the delivery room.
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