Knowledge
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Cardiac arrest is rare in pregnancy (1 in 30,000) and resuscitation is founded on the same approach used for the non-pregnant patient, focusing on:
- Recognition
- Calling for help
- A B C (D)
- Good for mother = good for baby
However, unique to maternal resuscitation:
- Airway difficulties are more likely.
- Aortocaval compression dramatically impedes resuscitation – employ left lateral tilt!
- Consider perimortem cesarean section
The rationale for Perimortem Cesarean Section is:
- The presence of baby and gravid uterus severely limits resuscitation of the mother.
- Emergency cesarean section at cardiac arrest is done for the mother’s benefit, not the baby.
- A decision to perform emergency CS must be made within 4 minutes of arrest, and the baby delivered within 5 minutes. (Although there is some evidence of benefit when performed up to 10 minutes after arrest.)
- The only equipment required is a scalpel and an appropriately skilled doctor.
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Continuous paravertebral block is an effective alternative to thoracic epidural for managing post-operative pain after open nephrectomy, with a better side-effect profile.
pearl
...and 1 more note
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Calabadions are heterocyclics molecule that offers rapid and complete reversal of both aminosteroids, such as rocuronium and vecuronium, and benzylisoquinoline NMBDS, such as atracurium and cisatracurium.
Notably, calabadion 2 binds rocuronium 89 times stronger than sugammadex. Additionally it also binds etomidate and ketamine.
Calabadions are still undergoing pre-human animal testing, and so are some time away from entering clinical practice.
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