Article Notes
Article pearls, summaries and comments.
- Recognition
- Calling for help
- A B C (D)
- Good for mother = good for baby
- Airway difficulties are more likely.
- Aortocaval compression dramatically impedes resuscitation – employ left lateral tilt!
- Consider perimortem cesarean section
- 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.
- Myth 1: Modern relaxants are so reliable and predictable that monitoring is unnecessary.
- Myth 2: Post-op residual paralysis is neither common or important.
- Myth 3: Post-op residual paralysis is easy to identify.
- Myth 4: Sugammadex makes residual paralysis a non-issue. (it might, but only if it is routinely available and used!)
- Myth 5: Using propofol and remifentanil we can avoid relaxants for intubation all together.
- Myth 6: Neuromuscular blockade has no effect on BIS.
Collection: The evidence for perimortem caesarean section
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:
However, unique to maternal resuscitation:
The rationale for Perimortem Cesarean Section is:
Collection: Neuromuscular myths: the lies we tell ourselves
An extensive collection of research debunking a range of myths and misconceptions regarding the way we use neuromuscular blocking drugs.
And bonus myth: deep relaxation is necessary for improving surgical access during laparoscopy.