ICU admissions from an obstetrical hospital

Stephens, Ian

doi:10.1007/bf03008207

Cited by 34 publications

(14 citation statements)

References 10 publications

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“…62 We identified 13 cases of front-of-neck access procedures after failed intubation at induction of general anaesthesia for caesarean section, as well as one at extubation and one after an abandoned caesarean section (Table 2). 7,15,29,33,48,49,64,88,90,[92][93][94] Six cases ended in maternal death and significant complications were reported in another that survived. There were eight cases of primary surgical tracheostomy and two performed after the failure of cricothyroidotomy.…”

Section: Supraglottic Airway Devicementioning

confidence: 99%

Failed tracheal intubation during obstetric general anaesthesia: a literature review

Kinsella

Winton

Mushambi

et al. 2015

International Journal of Obstetric Anesthesia

283

138

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We reviewed the literature on obstetric failed tracheal intubation from 1970 onwards. The incidence remained unchanged over the period at 2.6 (95% CI 2.0 to 3.2) per 1000 anaesthetics (1 in 390) for obstetric general anaesthesia and 2.3 (95% CI 1.7 to 2.9) per 1000 general anaesthetics (1 in 443) for caesarean section. Maternal mortality from failed intubation was 2.3 (95% CI 0.3 to 8.2) per 100000 general anaesthetics for caesarean section (one death per 90 failed intubations). Maternal deaths occurred from aspiration or hypoxaemia secondary to airway obstruction or oesophageal intubation. There were 3.4 (95% CI 0.7 to 9.9) front-of-neck airway access procedures (surgical airway) per 100000 general anaesthetics for caesarean section (one procedure per 60 failed intubations), usually carried out as a late rescue attempt with poor maternal outcomes. Before the late 1990s, most cases were awakened after failed intubation; since the late 1990s, general anaesthesia has been continued in the majority of cases. When general anaesthesia was continued, a laryngeal mask was usually used but with a trend towards use of a second-generation supraglottic airway device. A prospective study of obstetric general anaesthesia found that transient maternal hypoxaemia occurred in over two-thirds of cases of failed intubation, usually without sequelae. Pulmonary aspiration occurred in 8% but the rate of maternal intensive care unit admission after failed intubation was the same as that after uneventful general anaesthesia. Poor neonatal outcomes were often associated with preoperative fetal compromise, although failed intubation and lowest maternal oxygen saturation were independent predictors of neonatal intensive care unit admission.

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Section: Supraglottic Airway Devicementioning

confidence: 99%

Failed tracheal intubation during obstetric general anaesthesia: a literature review

Kinsella

Winton

Mushambi

et al. 2015

International Journal of Obstetric Anesthesia

283

138

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“…The shorter stay with epidural anaesthesia probably reflects the less frequent urgency for delivery as observed here, rather than a pure advantage of RA. Indeed, GA is an independent risk factor for ICU admission, as it is dictated in emergency caesarean section, and it is also preferred in coagulopathies and anticipated major haemorrhage [6, 12]. On the other hand, RA is preferred with expected difficult airway [13, 14].…”

Section: Discussionmentioning

confidence: 99%

The role of the post-anaesthesia care unit in the management of high-risk obstetric patients

Kostopanagiotou¹,

Kalimeris²,

Pandazi³

et al. 2011

aoms

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IntroductionHigh-risk obstetric patients in the immediate postpartum period are frequently admitted to the intensive care unit, but the necessity of this practice has recently been doubted. Herein we describe the efficiency of utilizing the post-anaesthesia care unit (PACU) as an intermediate intensive care facility for those patients.Material and methodsWe retrospectively described the reasons for admission, duration of stay, the anaesthetic used, main interventions and outcome for all obstetric admissions in the PACU during a period of 4 years in a university hospital.ResultsDuring the 4-year period 47 women were admitted to the PACU after delivery. The frequency of admission to the PACU was 15.3 per 1000 deliveries, while obstetric cases represented 4.4 per 1000 admissions to the PACU. The majority represented caesarean sections (81%). The main reasons for admission to the PACU were haemorrhage (49%), cardiovascular problems (19%) and preeclampsia/eclampsia (17%). Mean length of stay in the PACU was 14.5 ±11.6 h, being significantly less in women having received epidural anaesthesia (8.2 ±5.6 h) compared to those who delivered with general anaesthesia (19.0 ±13.6 h, p < 0.05). General anaesthesia was used in 85% of cases in which emergency delivery was indicated, but only in 27% of cases without emergency indications for delivery (p < 0.01). No death or admission to the intensive care unit occurred during the study period.ConclusionsThe PACU can offer an intermediate intensive care facility for high-risk obstetric patients, thus reducing unnecessary admissions to the intensive care unit.

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“…Anaphylactoid reactions are caused by activation of mast cells and release of the same substances but without activation of IgE antibodies. The only available diagnostic test of anaphylaxis is serum tryptase taken within one hour of the anaphylaxis 2 . Tryptase is an indicator of activation of mast cell and does not therefore differentiate between anaphylactic and anaphylactoid reactions or elucidate their cause.…”

Section: Discussionmentioning

confidence: 99%

Maternal anaphylactic reaction to a general anaesthetic at emergency caesarean section for fetal bradycardia

Stannard¹,

Bellis²

2001

BJOG

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A 31 year old woman primigravida was admitted in spontaneous labour at 38 weeks of gestation, having had an otherwise uneventful pregnancy. She was 1.66m tall and weighed 89kg at the time of her booking. Examination showed her cervix to be 4 cm dilated with the station of the fetal head 1cm above the ischial spines and that the membranes were intact. The fetal heart rate was 110 beats per minute (bpm) and cardiotocography was started which showed early decelerations. Arti®cial rupture of the membranes was performed and clear amniotic¯uid was drained. Diamorphine (10mg intramuscularly) was given for pain relief. There was no change in cervical dilatation at the next examination, and an oxytocin infusion was ordered. Epidural analgesia was administered.The epidural catheter was inserted without dif®culty and following a test dose of 3ml 2% lignocaine, her systolic/diastolic blood pressure was 166/74mmHg, with pulse rate 81 bpm. There were no signs of incorrect placement of the epidural catheter. During this time the fetal heart rate decreased to 70 bpm; this bradycardia did not respond to changing the position of the woman and the administration of oxygen. The fetal bradycardia persisted for seven minutes when a decision to perform a caesarean section was made. In view of this prolonged fetal bradycardia and the fact that the ®rst`top up ' had not yet been given through the epidural catheter, it was felt there was insuf®-cient time to establish adequate epidural anaesthesia for the caesarean section. The woman was transferred to the operating theatre and preparations made to administer general anaesthesia. No further drugs were administered into the epidural catheter.Based on an estimated weight of .100kg, thiopentone (500mg) and suxamethonium (100mg) were administered intravenously and endotracheal intubation was performed successfully. Immediately after the intubation, her pulse, blood pressure, oxygen saturation and end-tidal CO 2 were normal; and bilateral air entry into the lungs was con®rmed by auscultation. The endotracheal tube was then secured and mechanical ventilation started. Soon thereafter ventilation became rapidly progressively dif®cult, and her oxygen saturation decreased to 80-90%. The endotracheal tube was found to be patent and in the correct position, and 100% oxygen was given. Despite this her oxygen saturation decreased to 60%, auscultation of the chest revealed respiratory and expiratory rhonchi, and a diagnosis of anaphylaxis was considered. Her pulse became weak, her heart rate was less than 40 beats per minute, her blood pressure was unrecordable, her oxygen saturation was less than 50% and her end-tidal CO 2 , 10mmHg. Other than the severe bronchospasm and cardiovascular collapse, there were no other signs of anaphylaxis such as urticaria and angioreuratic oedema.Adrenaline (1mg intravenously) was given, cardiopulmonary resuscitation was started and a caesarean section was performed to facilitate maternal resuscitation. Four and a half minutes had elapsed between the intravenous induct...

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ICU admissions from an obstetrical hospital

Cited by 34 publications

References 10 publications

Failed tracheal intubation during obstetric general anaesthesia: a literature review

Failed tracheal intubation during obstetric general anaesthesia: a literature review

The role of the post-anaesthesia care unit in the management of high-risk obstetric patients

Maternal anaphylactic reaction to a general anaesthetic at emergency caesarean section for fetal bradycardia

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