Article Notes
- Northern Territorians are "... three times more likely to die on the roads than people living in other parts of Australia, and at a rate that is equivalent to that in many low- and middle-income countries."
- After the last open speed limits were abolished in 2007, the "Australian road deaths database shows a decrease in fatalities of 3.4 per year on those NT roads..."
This follow-up paper to Hawkin's original "Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990" showed a dramatic improvement in the relative risk of cesarean section death with general vs regional anesthesia compared with the original 1979-1990.
Where previously (1979-1990) the relative risk of death during GA CS was 16.7, from 1997-2002 the relative risk had fallen to 1.7. Worryingly though this was both due to a falling mortality rate for GA CS and an increasing mortality rate for regional anesthesia CS.
Cesarean section under general anesthesia still exposes mothers to an increased risk of perioperative death, but this risk is much lower than previously, likely due to better anesthesia training, supervision and respect of the obstetric airway.
This historical landmark paper demonstrated the terribly-higher maternal mortality during cesarean section performed under general anesthesia vs regional anesthesia in the United States from 1979-1990.
This resulted in the oft-quoted statistic of being '...17 times more likely to die under a GA cesarean section than epidural or spinal.'
It is very important to note that this is a historical article and that the demonstrated very high mortality was greatly contributed to by a culture tolerating inexperienced anesthesia residents performing GA CS after-hours with limited senior support.
Hawkins followed up this study with another in 2011: Anesthesia-related maternal mortality in the United States: 1979-2002. This reassuringly showed a much improved GA CS maternal mortality from 1997-2002 (although still higher than regional CS).
The important take-home from this paper is that a GA cesarean section increases the risk of serious airway events, and if this is not managed by experienced and appropriately trained anaesthetists/anesthesiologists, will result in maternal deaths.
A case study describing a total spinal occurring in a 26 year old having an emergency caesarean section for failure to progress.
On arrival in theatre a block to pin prick was noted to T12, with the last epidural top-up having been 90 minutes earlier with only 5 mL of 0.25% bupivacaine. Total volume of epidural LA is not reported.
The epidural had partially dislodged, so anaesthesia was with 10.5 mg of spinal bupivacaine (equivalent to 2.1mL of 0.5%) resulting in a block to T6. 10 minutes later the patient became distressed, followed by respiratory arrest and unconsciousness.
Baby was delivered uneventfully and the mother made a full recovery. The authors ascribed the case to a total spinal resulting from cephalad spread of intrathecal bupivacaine.
A clear and nuanced critique of the Northern Territory government's policy of removing speed limits on sections of the Stuart Highway. Read explores evidence linking driving speed and posted speed limits with vehicle accidents and trauma, noting that for the Territory:
He concludes that the NT needs a stronger road safety package that includes removing unlimited speed limits along with driver fatigue, alcohol and seatbelt interventions.
Crash risk and trauma severity are directly related to vehicle speed and posted speed limit.