Cardiac Arrest in a Morbidly Obese Patient with Undiagnosed Cardiomyopathy after Spinal Anaesthesia for Caesarean Section – a Case Report

Abstract

A 34-year old gravida 5, para 1 +3 (none alive), presented with an 8-hour history of labour at 36 weeks gestation. On examination, she was grossly obese (BMI 43), had a pulse rate of 92 bpm, blood pressure of 100/70 mmHg and bilateral pedal oedema. She had a singleton fetus, lying transverse. Emergency Caesarean section was planned. In the operating theatre, she had spinal (subarachnoid) blockade with a 25-G Whitacre spinal needle and 2.2 ml of 0.5 % hyperbaric bupivacaine. Shortly thereafter, she complained of a progressively worsening respiratory difficulty, for which she was intubated and ventilated. Large amounts of blood -stained frothy fluid poured out of the pharynx at laryngoscopy, and from the endotrachial tube after intubation. She had cardiac arrest, and all resuscitative efforts failed.