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Anesthesiology:
Clinical Investigation

Anesthesia‐related Deaths during Obstetric Delivery in the United States, 1979–1990

Hawkins, Joy L. MD; Koonin, Lisa M. MN, MPH; Palmer, Susan K. MD; Gibbs, Charles P. MD

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Abstract

Background: Anesthesia‐related complications are the sixth leading cause of pregnancy‐related death in the United States. This study reports characteristics of anesthesia‐related deaths during obstetric delivery in the United States from 1979–1990.
Methods: Each state reports deaths that occur within 1 yr of delivery to the Centers for Disease Control and Prevention as part of the ongoing Pregnancy Mortality Surveillance. Maternal death certificates (with identifiers removed) matched with live birth or fetal death certificates when available from 1979–1990 were reviewed to identify deaths due to anesthesia, the cause of death, the procedure for delivery, and the type of anesthesia provided. Maternal mortality rates per million live births were calculated. Case fatality rates and risk ratios were computed to compare general to regional anesthesia for cesarean section deliveries.
Results: The anesthesia‐related maternal mortality rate decreased from 4.3 per million live births in the first triennium (1979–1981) to 1.7 per million in the last (1988–1990). The number of deaths involving general anesthesia have remained stable, but the number of regional anesthesia‐related deaths have decreased since 1984. The case‐fatality risk ratio for general anesthesia was 2.3 (95% confidence interval [CI], 1.9–2.9) times that for regional anesthesia before 1985, increasing to 16.7 (95% CI, 12.9–21.8) times that after 1985.
Coclusions: Most maternal deaths due to complications of anesthesia occurred during general anesthesia for cesarean section. Regional anesthesia is not without risk, primarily because of the toxicity of local anesthetics and excessively high regional blocks. The incidence of these deaths is decreasing, however, and deaths due to general anesthesia remain stable in number and hence account for an increased proportion of total deaths. Heightened awareness of the toxicity of local anesthetics and related improvements in technique may have contributed to a reduction in complications of regional anesthesia.
Death due to anesthesia is the sixth leading cause of pregnancy‐related mortality in the United States. [1,2] Despite advances in the safety and administration of anesthesia for obstetric procedures, complications leading to death still occur. Deaths from this cause are particularly lamentable because many of these anesthetics are elective, they are provided to young mothers in the prime of life, and some might be prevented if more experienced personnel were provided. [3,4]
Anesthesiologists in the United States have historically relied on data from the Report on Confidential Enquiries into Maternal Deaths in the United Kingdom to describe the causes and incidence of anesthesia‐related complications that lead to maternal death. [5] These analyses are thorough and include extensive information on each case, but differences in styles of practice may preclude applying the results directly to the practice of obstetric anesthesia in the United States. Although the total numbers of deaths from complications of anesthesia during pregnancy in this country have been reported, [2,6] analyses of national data on anesthetic‐related deaths have not been published previously. We studied maternal deaths reported in the United States from 1979–1990 to determine the cause, the relation to the type of anesthetic, the type of obstetric procedure performed, and any associated maternal conditions. Although a detailed analysis of each case was precluded because complete information was not available from vital records, this study offers a first national look at the magnitude and causes of anesthesia‐related pregnancy deaths. An understanding of the risks of obstetric anesthesia should make it possible to provide recommendations to improve the care of all parturients and to decrease the number of deaths from this cause.
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Materials and Methods

In 1987, the Centers for Disease Control and Prevention (CDC) established an ongoing National Pregnancy Mortality Surveillance System, which is a system to monitor maternal deaths at the national level and conduct epidemiologic studies of the deaths of pregnant women. [7] Health departments in all 50 states, the District of Columbia, and New York City provided the CDC with copies of death certificates (with patient and provider identification removed) and, when available, the linked pregnancy outcome records (birth certificates and fetal death records) for all identified pregnancy‐related deaths from 1979 through 1990.
A woman's death was classified as pregnancy related if it occurred during pregnancy or within 1 yr after delivery and resulted from (1) complications of the pregnancy itself, (2) a chain of events initiated by the pregnancy, or (3) the aggravation of an unrelated condition by the physiologic or pharmacologic effects of pregnancy. [2] Clinical epidemiologists reviewed each pregnancy‐related death certificate and, when available (89% of cases), the matched pregnancy outcome record for a possible relation to anesthesia. Three obstetric anesthesiologists independently reviewed the maternal death certificates and matched live birth or fetal death certificates for each of the cases to confirm that the death resulted from a complication of anesthesia. If all three anesthesiologists confirmed from the vital records information that the death resulted from an anesthesia‐related complication, they then determined the cause of death, procedure for delivery, and type of anesthesia provided. Because vital records are often incomplete concerning the events surrounding the death, if all three anesthesiologists evaluating the records independently could not agree, the information was coded as unknown.
We classified deaths by the CDC system, which distinguishes among the immediate and underlying causes of death as stated on the death certificate, associated obstetrical conditions or complications, and the outcome of pregnancy. [2] Complications of anesthesia leading to death were further categorized as airway management problems, which included aspiration of gastric contents, problems with induction or intubation during general anesthesia and esophageal intubation, inadequate ventilation, and respiratory failure; high spinal or epidural block; toxicity of local anesthetics; drug reactions, anaphylaxis, or both; overdose of sedatives; or unknown cause. Because some of the death certificates only listed cause of death as “cardiac arrest,” these deaths were included in a category labeled “unspecified intraoperative cardiac arrest during anesthesia.”
All pregnancy‐related deaths (n = 4,097) submitted to the CDC for 1979–1990 were reviewed, and it was determined that 155 deaths were caused by anesthesia‐related complications. After an initial analysis of these cases, the 20 abortion‐related deaths and the six deaths related to ectopic pregnancy were excluded so that 129 cases associated with an obstetric delivery (live births or stillbirths) were evaluated. We calculated pregnancy mortality rates per million live births using national data on live births from the 1979–1990 natality files of the National Center for Health Statistics.
To compare the risks of general versus regional anesthesia during cesarean section, we estimated case‐fatality rates for two time periods: 1979–1984 and 1985–1990. We used these periods for three reasons: (1) The annual number of anesthesia‐related deaths were too small to compute reliable annual rates, (2) the two time periods divided the study period into equal 6‐yr blocks, and (3) changes in the clinical practice of obstetric regional anesthesia occurred after 1984 with the withdrawal of 0.75% bupivacaine for epidural injection from clinical practice. This latter change may have influenced rates of mortality from local anesthetic toxicity.
Case‐fatality rates were computed by the following procedure. First, we determined the national number of live births for each year during the period 1979–1990. Second, we applied national cesarean section rates for each year, derived from National Hospital Discharge Survey data, to the number of live births, and then calculated the number of cesarean section deliveries for each of the two periods. [8] This estimate was then apportioned to administration of general and regional anesthesia according to estimated percentages from survey data from obstetric anesthesia personnel. For the years 1979–1984, the percentages of women who received regional or general anesthesia for cesarean section were estimated from a survey of obstetricians and anesthesia personnel conducted in 1981. [9] The average cesarean section rate during that time was 19% [8]; general anesthesia was used in approximately 41% of cases, and regional anesthesia was used in approximately 55%. [9] (According to the authors, these values add up to less than 100% because some respondents failed to answer all questions.) For the period 1985‐ 1990, we obtained data on anesthesia administration from a similar survey of obstetricians and anesthesia personnel conducted in 1992. [10] Although 1992 falls outside the study period, no major changes in obstetric anesthesia practice occurred from 1990–1992. The average cesarean section rate during the later period was 24%, [8] the use of general anesthesia had declined to approximately 16% of cesarean sections, and regional anesthesia was used in approximately 84% of cases. [10]
The two manpower surveys used for these estimates were conducted in a similar manner. [9,10] Using the American Hospital Association registry, hospitals were differentiated by number of births occurring in that year and by U.S. Census region, and a stratified random sample of hospitals was selected. Two copies of the survey were sent to the administrator of each hospital, one for the chief of obstetrics and one for the chief of anesthesiology. In 1981, 1,193 surveys were returned (48% from obstetricians and 52% from anesthesiologists) and responding hospitals represented about 30% of the total births in the United States that year. In 1992, 902 surveys were returned (51% from obstetricians and 49% from anesthesiologists) and births at responding hospitals represented 56% of the total U.S. births occurring that year.
Finally, we calculated case‐fatality rates by dividing the number of deaths associated with general or regional anesthesia during cesarean section in a given period by the estimated number of administrations of that type of obstetric anesthesia during cesarean section delivery in the same period. We used regional anesthesia as the referent for comparison with the risk associated with general anesthesia. For the resulting case‐fatality rates and risk ratios, we based 95% confidence intervals (CI) on the logit case‐fatality rate and used the Taylor series method for variances. [11]
To compare U.S. data for 1979–1990 with data from England and Wales, we calculated pregnancy mortality rates by triennium. Because we based the denominator for U.S rates on the number of live births, whereas the rates from England and Wales are based on all “maternities” (tile count of mothers who delivered live births, stillbirths, pregnancy terminations, ectopic pregnancies, and abortions), these rates are not perfectly analogous but should allow for some degree of comparison. [5]
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Results

Table 1
Table 1
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Characteristics of the 129 women who died of complications of anesthesia during delivery in the study period 1979–1990 are shown in Table 1. Seventy‐nine percent of these women were 20 to 34 yr old, and 52% were black. They tended to have 12 or more years of education and to have begun prenatal care in the first trimester of pregnancy (Table 1). Most women who died from complications of anesthesia in this study were undergoing a cesarean delivery (82%). Approximately 5% of the deaths were associated with a vaginal delivery, and for 13% the delivery procedure could not be determined.
Table 2
Table 2
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The causes of anesthesia‐related death varied by the type of anesthesia administered (Table 2). The 67 women who died of complications of general anesthesia (52% of the deaths) primarily died of airway management problems, which included aspiration, induction or intubation problems, inadequate ventilation, and respiratory failure. About one fourth (n = 33) of the 129 deaths from anesthesia‐related complications were associated with problems that occurred during the administration of regional anesthesia. Most deaths from regional anesthesia (70%) occurred among women who had epidural anesthesia; the remaining 30% were associated with spinal anesthesia. These deaths usually resulted from local anesthetic toxicity or an inadvertent high spinal or epidural block. Four deaths (3%) were related to complications of parenteral opioids or sedatives. In three or four cases, airway management problems were the cause of these deaths. The type of anesthesia was not available in the vital records for 25 (19%) of the women, but the causes of death appeared to be similar to those for women who died of complications of general anesthesia (Table 2). Cardiac arrest during anesthesia was listed as the only cause of death in 30 cases (23% of the total), but information was inadequate to determine the underlying cause. Analysis by type of anesthesia showed that 50% of these events occurred during general anesthesia and 7% during regional anesthesia; in 43% of these cardiac arrest cases we could not determine the type of anesthesia used.
Figure 1
Figure 1
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The type of anesthesia associated with maternal deaths changed during the 12‐yr study period (Figure 1). The number of deaths from complications of anesthesia during delivery decreased with time. In the first half of the study (trienniums 1979–1981 and 1982–1984), deaths from general anesthesia accounted for about 41% of the cases and deaths from regional anesthesia accounted for 28–31%. Most deaths related to general anesthesia during this period resulted from aspiration and intubation problems, and most deaths related to regional anesthetic resulted from local anesthetic toxicity (Table 2). In contrast, after 1984 there was an abrupt decrease in deaths due to regional anesthesia. Fewer deaths due to local anesthetic toxicity were reported after 1984. The number of anesthesia‐related deaths in which cause of death and characteristics of the woman were unknown also decreased with time.
Table 3
Table 3
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We calculated case‐fatality rates for women who had a cesarean section delivery with general or regional anesthesia for the two periods 1979–1984 and 1985–1990 (Table 3). The estimated rate of death from complications of general anesthesia during cesarean section increased from 20 deaths per million general anesthetics administered in the earlier time period to 32.3 deaths per million during the latter. In contrast, the rate of death during cesarean section delivery using regional anesthesia decreased from 8.6 per million regional anesthetics administered to 1.9 per million during the last half of the study period. From 1979–1984, the risk of death from complications of general anesthesia during cesarean delivery was 2.3 (95% CI, 1.9–2.9) times higher than that for regional anesthesia. From 1985–1990, the rate of death related to regional anesthesia decreased, and concomitantly the use of regional anesthesia for cesarean section delivery increased. Therefore the risk of death from complications of general anesthesia increased to 16.7 (95% CI, 12.9–21.8) times that for regional anesthesia.
Table 4
Table 4
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We have used the format of the Report on Confidential Enquiries into Maternal Deaths in the United Kingdom to show anesthesia‐related maternal mortality rates (deaths per million live births or maternities) in the United States and England and Wales by triennium (Table 4). In the United States, this maternal mortality rate has decreased in each subsequent 3‐yr period from 4.3 per million in 1979–1981 to 1.7 per million in 1988–1990. The rates in England and Wales have also decreased.
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Discussion

Maternal mortality rates have decreased during the 12‐yr period of this study. This decrease is reflected by data from both the United States and England and Wales. [12] The 1991 Confidential Enquiries report noted, “The actual reduction in the direct mortality rate due to anaesthesia is probably greater than that suggested by the decrease in the number of deaths, since the number of anaesthetics for operative procedures continues to rise.” [5] This position is also supported by data from the United States. [8] Cesarean delivery rates in the United States increased from 16% to 24% during the years of our study. Anesthesia‐related deaths primarily occur during cesarean section, with at least 82% in this study (Table 1). Other studies have found that the risk for maternal death is significantly greater for women undergoing cesarean section than for those who have a vaginal delivery. [13] The increased risk of cesarean delivery may be related not only to the labor or delivery complications necessitating the cesarean section but also to the specific risks of anesthesia for this method of delivery. Management of anesthesia for cesarean section is more complex than for vaginal delivery and is more likely to involve general anesthesia and airway management. In this country, the American Society of Anesthesiologists Closed Claims Study has also shown that maternal death claims are predominantly related to use of general anesthesia. [14] Furthermore, 100% of parturients are exposed to the risk of anesthesia when they have a cesarean delivery. In contrast, a 1981 survey of obstetricians and anesthesiologists showed that only 16% of parturients received an anesthetic for labor (other than parenteral medications). [9] A similar survey in 1992 showed that 37% received regional analgesia. [10]
This study represents the first assessment of national data on maternal deaths related to anesthesia in the United States. Because this report is based on a national surveillance system and vital records, it lacks the detailed case data used in the reports from the United Kingdom. Nevertheless, it provides the best possible view of trends in anesthesia‐related death in the United States. Previous studies of maternal death due to complications of anesthesia have been conducted only on a state level. [15–17] However, the number of anesthesia‐related deaths for each state is so small it precludes definitive analysis. In addition, concerns about confidentiality when such small numbers are involved have curtailed the activities of many state committees on maternal death. [6,18] When studies use maternal mortality data from a national data bank, with larger numbers, confidentiality is better preserved and results have wider applicability.
Several important limitations of this study should be considered. First, not all maternal deaths are identified as such on death certificates. For example, if a woman dies from complications of pulmonary aspiration after an extended 6‐week stay in an intensive care unit, the person completing the death certificate may not remember to indicate that the woman was pregnant. It has been estimated that as many as 37% of maternal deaths are missed due to underreporting on vital statistics records. [19,20] Second, because death certificates are not designed to collect medical data and are completed by persons with varying backgrounds and training, these certificates often do not contain enough detail to determine the circumstances and pathophysiologic conditions leading to the maternal death. For example, the cause of death may be listed simply as “cardiac arrest under anesthesia.” In this instance, not only was the true cause of death unknown, but the type of anesthesia was also unknown. Nevertheless, it is obvious that the cause of death was related to anesthesia. Finally, reporting bias can lead to missed cases. In the review by Kaunitz et al. [6] of maternal mortality in the United States, the investigators reported that some deaths reportedly due to amniotic fluid embolism may actually have been due to complications of anesthesia. Syverson et al. [21] also noted that deaths classified as “cardiac arrest” on vital records often mentioned complications of anesthesia when autopsy reports or medical records were reviewed.
In this study, all cases mentioning anesthesia as a cause of death were included. If all three anesthesiologists evaluating the records independently could not agree on the rest of the information, it was coded as unknown. This approach was in part responsible for much of the of data classified as “unknown.” However, it reduced the extent of speculation as to what happened.
Our results indicate that the number of deaths due to complications of general anesthesia, although small, is not decreasing over time‐a discouraging finding given the marked decrease in the use of general anesthesia in the last decade. The decrease in anesthesia‐related deaths seems to have been due to a decrease in complications of regional anesthesia, but because of large categories of unknowns, this interpretation is offered with caution. During the study period there was a marked increase in the use of regional anesthesia. In 1981, regional anesthesia was used in 55% of cesarean deliveries, whereas in 1992 it was used in 84%. [9,10] In contrast, use of general anesthesia for cesarean delivery has decreased sharply, from 41% to 16%, during the same period. The increased relative risk of general anesthesia may result from the fact that regional anesthesia was being used for lower‐risk elective procedures in the later time period (1985–1990), such as patients requesting labor analgesia or elective cesarean sections. General anesthesia may have been used primarily in emergency situations, in patients for whom regional anesthesia was difficult to administer (a morbidly obese patient), or when regional anesthesia was contraindicated (a patient with a coagulation disorder due to hemorrhage or preeclampsia). [22] This hypothesis is supported by the findings of Endler et al., [17] who noted three risk factors for anesthesia‐related maternal death: obesity (present in 80% of cases), emergency surgery (occurring in 80% of cases), and hypertension (present in 53% of cases), which are all potential reasons why general anesthesia rather than regional anesthesia might be necessary. Morbid obesity has been recognized in other analyses as a risk factor for airway problems and death from complications of anesthesia. [23] Although patient weight was not available for most cases we analyzed, when additional records were available, obesity was frequently noted in “can't intubate‐can't ventilate” situations. Morgan et al. [24] recommend that a “prophylactic” epidural catheter be placed in patients in whom intubation is judged to be potentially difficult so that regional anesthesia can be used if emergent delivery is needed.
In 30 cases, the cause of death was listed as cardiac arrest, and a more direct cause could not be determined from the data available (Table 2). In the cases in which anesthesia type was known, 15 of 17 involved general anesthesia. In addition, data pooled from cases in the Confidential Enquiries revealed that 66% of cardiac arrest deaths involved airway management problems (esophageal intubation, difficult tracheal intubation, postoperative hypoventilation, and equipment failure such as a ventilator disconnect or kinked endotracheal tube). [22] Thus it is unlikely that a significant number of these deaths were related to regional anesthesia as described in the Closed Claims analyses. [25] However, without further information about each case, we cannot know definitively.
We were intrigued that the number deaths due to local anesthetic toxicity decreased abruptly after 1984 (Figure 1). The decrease in deaths due to regional anesthesia seems temporally related to the national debate about 0.75% bupivacaine, its relation to large intravenous doses having special cardiotoxic effects, and its discontinuance from obstetric anesthesia practice in 1984. [26,27] * At that time, anesthesiologists developed an increased awareness of the toxicity of local anesthetics, and protocols for test doses and fractionation of large doses of local anesthetics became standard practice. Our results reveal a reduction in deaths temporally related to these changes in practice, although we did not have information on the use of a test dose or the total doses of local anesthetic used.
Case‐fatality rates computed in this analysis (Table 3) must be interpreted with caution because they were computed from other estimations (see Materials and Methods). Nevertheless, they indicate a notable difference in the risk for death from general rather than regional anesthesia complications; the risk ratio has increased eight times from 1979–1984 to 1985–1990. Although the case‐fatality rates from regional anesthesia have decreased markedly, the great difference in risk during delivery is still cause for concern. If we assume that the patient with a more acute or complex condition (e.g., severe preeclampsia or morbid obesity) is more likely to receive general anesthesia in some settings, the apparent higher risk from complications of general anesthesia may be, in part, a result of the higher acuity level of these patients.
To ensure continuing awareness of the anesthetic causes of maternal death and to improve preventive measures, more states should develop active maternal mortality committees and involve anesthesiologists in case reviews. Efforts should be made to improve availability and reporting of information regarding maternal deaths. More complete information about each maternal death associated with obstetric anesthesia and continued comprehensive studies of maternal deaths due to complications of anesthesia will allow researchers and clinicians to develop strategies to prevent this type of death.
The authors thank Paul M. Gargiullo, Ph.D., for statistical assistance.
*Abbott Laboratories: Letter to doctors: Urgent new recommendations about bupivacaine. Westboro, MA, Astra Pharmaceutical Products, Breon Laboratories, 1984.
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Lupus
Anaesthesiological aspects of pregnancy in patients with rheumatic diseases
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International Journal of Obstetric Anesthesia
Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: A retrospective analysis of 19,259 deliveries
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Journal of Anesthesia
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Journal of Maternal-Fetal & Neonatal Medicine
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Kuczkowski, KM
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Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
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Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 33(8): 489-496.

Anesthesia and Analgesia
Anesthesia for cesarean section and acid aspiration prophylaxis: A German survey
Schneck, H; Scheller, M; Wagner, R; von Hundelshausen, B; Kochs, E
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Gynakologe
Anesthesia in caesarean section - Recent developments
Strasser, K; Van Aken, H
Gynakologe, 30(): 850-854.

Obstetrics and Gynecology
Obstetricians' ability to assess the airway
Gaiser, RR; McGonigal, ET; Litts, P; Cheek, TG; Gutsche, BB
Obstetrics and Gynecology, 93(5): 648-652.

International Journal of Obstetric Anesthesia
The demise of general anesthesia in obstetrics revisited: prescription for a cure
Lipman, S; Carvalho, B; Brock-Utne, J
International Journal of Obstetric Anesthesia, 14(1): 2-4.
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Canadian Medical Association Journal
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Medicina Clinica
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Thrombosis and Haemostasis
Obstetric analgesia and anaesthesia in women with inherited bleeding disorders
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Recent Views on Clinical Pain, Proceedings
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International Journal of Obstetric Anesthesia
Very low-dose spinal anesthesia for cesarean section in a morbidly obese preeclamptic patient and its potential implications
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International Journal of Obstetric Anesthesia
Spinal anesthesia for cesarean section following inadequate labor epidural analgesia: a retrospective audit
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International Journal of Obstetric Anesthesia, 13(4): 239-243.

European Journal of Anaesthesiology
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Pharmacoepidemiology and Drug Safety
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Anesthesia and Analgesia
Safety steps for epidural injection of local anesthetics: Review of the literature and recommendations
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Anesthesiology
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Anaesthesia, Pain, Intensive Care and Emergency Medicine - Apice 14
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Journal of Clinical Anesthesia
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
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International Journal of Obstetric Anesthesia
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Paediatric Anaesthesia
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Anesthesia and Analgesia
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Proceedings of the 8Th World Congress of Perinatal Medicine
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Anesthesia and Analgesia
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Pakistan Journal of Medical Sciences
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Anaesthesia
Spinal anaesthesia and caesarean section in a patient with hypofibrinogenaemia and factor XIII deficiency
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Anesthesia and Analgesia
Successful epidural anesthesia for cesarean section for sextuplets
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Anaesthesist
Sevoflurane in obstetric anaesthesia
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Anaesthesist
Peripheral neuronal blockade. A review of new developments of an old technique
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British Medical Journal
Interval between decision and delivery by caesarean section - are current standards achievable? Observational case series
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Critical Care Clinics
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Anaesthesia
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Anasthesiologie & Intensivmedizin
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Zdravniski Vestnik-Slovenian Medical Journal
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
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Anesthesia and Analgesia
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
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Proceedings of the 7Th Biennial Congress Asian & Oceanic Society of Regional Anesthesia & Pain Medicine
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British Medical Journal
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International Journal of Obstetric Anesthesia
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Anesthesia and Analgesia
A Systematic Review of Randomized Controlled Trials That Evaluate Strategies to Avoid Epidural Vein Cannulation During Obstetric Epidural Catheter Placement
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Proceedings of the Xxi European Congress of Perinatal Medicine
Regional Anaesthesia for Primary Caesarean Section in Patients with HELLP Syndrome
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Anaesthesia
Litigation related to regional anaesthesia: an analysis of claims against the NHS in England 1995-2007
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Pediatrics
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Tarshis, J; Camann, WR; Datta, S
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Clinical Pharmacokinetics
Clinical pharmacokinetics of neuromuscular relaxants in pregnancy
Guay, J; Grenier, Y; Varin, F
Clinical Pharmacokinetics, 34(6): 483-496.

Journal of Clinical Anesthesia
Equipment for the difficult airway in obstetric units in Germany
Stamer, UM; Messerschmidt, A; Wulf, H; Hoeft, A
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Anaesthesia
Training in obstetric general anaesthesia: a vanishing art?
Tsen, LC; Camann, W
Anaesthesia, 55(7): 712-713.

Anesthesia and Analgesia
Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: A prospective cohort comparison
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Anaesthesia
Caesarean section in a cocaine-intoxicated parturient: regional vs. general anaesthesia?
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Journal of Clinical Anesthesia
The epidural test dose in obstetric anesthesia: It is not obsolete
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
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Anesthesia and Analgesia
Failure of Augmentation of Labor Epidural Analgesia for Intrapartum Cesarean Delivery: A Retrospective Review
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Acta Anaesthesiologica Scandinavica
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Regional Anesthesia and Pain Medicine
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Gynakologe
Risks involved in cesarean section and vaginal birth
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Pharmacoeconomics
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Obstetrics and Gynecology
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Anesthesia and Analgesia
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Pediatric Anesthesia
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Journal of Midwifery & Womens Health
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International Journal of Obstetric Anesthesia
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Anesthesia and Analgesia
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American Journal of Obstetrics and Gynecology
Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy
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New England Journal of Medicine
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Drugs
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Samj South African Medical Journal
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Annales Francaises D Anesthesie Et De Reanimation
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International Journal of Obstetric Anesthesia
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Baillieres Clinical Obstetrics and Gynaecology
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Anesthesiology
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Anaesthesia
Anaesthesia for Caesarean section: a survey in a UK region from 1992 to 2002
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Acta Anaesthesiologica Scandinavica
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International Journal of Obstetric Anesthesia
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Seminars in Perinatology
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International Journal of Obstetric Anesthesia
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
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Anesthesia and Analgesia
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British Journal of Obstetrics and Gynaecology
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
The evolving role of the laryngeal mask airway in obstetrics
Preston, R
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie, 48(): 1061-1065.

Journal of Clinical Anesthesia
Laryngeal nerve monitoring during thyroid surgery in pregnancy
Shankar, KB; Posner, M; Moore, FD; O'Rourke, N
Journal of Clinical Anesthesia, 17(5): 369-371.
10.1016/j.jclinane.2004.07.010
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Non-invasive ventilation corrects alveolar hypoventilation during spinal anesthesia
Ferrandiere, M; Hazouard, E; Ayoub, J; Laffon, M; Gage, J; Mercier, C; Fusciardi, J
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie, 53(4): 404-408.

Cochrane Database of Systematic Reviews
Routine prophylactic drugs in normal labour for reducing gastric aspiration and its effects
Gyte, GML; Richens, Y
Cochrane Database of Systematic Reviews, (3): -.
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Cochrane Database of Systematic Reviews
Regional versus general anaesthesia for caesarean section
Afolabi, BB; Lesi, FEA; Merah, NA
Cochrane Database of Systematic Reviews, (4): -.
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Providing oral nutrition to women in labor
[Anon]
Journal of Midwifery & Womens Health, 53(3): 276-283.
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Anaesthesia
A prospective audit of regional anaesthesia failure in 5080 Caesarean sections
Kinsella, SM
Anaesthesia, 63(8): 822-832.
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British Medical Journal
Has medicalisation of childbirth gone too far? Regional analgesia in labour permits childbirth without fear
Camann, W
British Medical Journal, 325(): 103-104.

Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Guilt by association?
Bates, JN; Mensink, F
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie, 49(7): 761.

Anesthesia and Analgesia
Spinal anesthesia for cesarean delivery shortly after an epidural blood patch
Loughrey, JPR; Eappen, S; Tsen, LC
Anesthesia and Analgesia, 96(2): 545-547.
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Anesthesia and Analgesia
Ethics: An essential dimension of clinical obstetric anesthesia
Chervenak, FA; McCullough, LB; Birnbach, DJ
Anesthesia and Analgesia, 96(5): 1480-1485.
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International Journal of Obstetric Anesthesia
Epidural top-ups for category I/II emergency caesarean section should be given only in the operating theatre - Introduction
Russell, IF
International Journal of Obstetric Anesthesia, 13(4): 259-265.
10.1016/j.ijoa.2004.07.004
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Anesthesia and Analgesia
Remifentanil for fetal immobilization and maternal sedation during fetoscopic surgery: A randomized, double-blind comparison with diazepam
Van De Velde, M; Van Schoubroeck, D; Lewi, LE; Marcus, MAE; Fani, JC; Missant, C; Teunkens, A; Deprest, JA
Anesthesia and Analgesia, 101(1): 251-258.
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Acta Anaesthesiologica Scandinavica
Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section
Orbach-Zinger, S; Friedman, L; Avramovich, A; Ilgiaeva, N; Orvieto, R; Sulkes, J; Eidelman, LA
Acta Anaesthesiologica Scandinavica, 50(8): 1014-1018.
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Anesthesiology
Institutional review of general anesthesia for cesarean section in 2006
Cassidy, AL; Hudson, JC; Colquhoun, AD
Anesthesiology, 106(5): B108.

Acta Anaesthesiologica Scandinavica
Obstetric anesthesia for the obese and morbidly obese patient: an ounce of prevention is worth more than a pound of treatment
Soens, MA; Birnbach, DJ; Ranasinghe, JS; van Zundert, A
Acta Anaesthesiologica Scandinavica, 52(1): 6-19.
10.1111/j.1399-6576.2007.01483.x
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Acta Anaesthesiologica Scandinavica
Anaesthesia for caesarean section - a German survey
Stamer, UM; Messerschmidt, A; Wulf, H
Acta Anaesthesiologica Scandinavica, 42(6): 678-684.

International Journal of Obstetric Anesthesia
Lessons learned from the bupivacaine experience
Eldridge, J; Russell, R
International Journal of Obstetric Anesthesia, 7(3): 189.

Journal of Clinical Anesthesia
Common mechanisms and strategies for prevention and treatment of cardiac arrest during epidural anesthesia
Pollard, JB
Journal of Clinical Anesthesia, 14(1): 52-56.
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Anaesthesist
Oral premedication for caesarean section
Jacob, M
Anaesthesist, 51(3): 219-220.

Journal of Clinical Anesthesia
Airway problems and new solutions for the obstetric patient
Kuczkowski, KM; Reisner, LS; Benumof, JL
Journal of Clinical Anesthesia, 15(7): 552-563.
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International Journal of Clinical Practice
Levobupivacaine and ropivacaine: the new choices for labor analgesia
Kuczkowski, KM
International Journal of Clinical Practice, 58(6): 604-605.

Journal of Clinical Anesthesia
Severe maternal bradycardia and asystole after combined spinal-epidural labor analgesia in a morbidly obese parturient
Pan, PH; Moore, CH; Ross, VH
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Acta Anaesthesiologica Scandinavica
Epidural ropivacaine 1% with and without sufentanil addition for Caesarean section
Bachmann-Mennenga, B; Veit, G; Biscoping, J; Steinicke, B; Heesen, M
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Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
Difficult airway management
Gerlach, K; Dorges, V; Uhlig, T
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Journal of Maternal-Fetal & Neonatal Medicine
Obstetric anesthesia: Past present and future
Kuczkowski, KM
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Local anesthetic systemic toxicity
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International Journal of Obstetric Anesthesia
General anesthesia is unacceptable for elective cesarean section
Wong, CA
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Australian & New Zealand Journal of Obstetrics & Gynaecology
A survey of factors influencing patients' choice of anaesthesia for caesarean section
Kee, WDN; Hung, VYS; Roach, VJ; Lau, TK
Australian & New Zealand Journal of Obstetrics & Gynaecology, 37(3): 300-303.

Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Fibreoptic bronchoscope and unexpected failed intubation - Reply
Crosby, E; Preston, R
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie, 46(8): 806-807.

Mount Sinai Journal of Medicine
Advances in Labor analgesia
Beilin, Y
Mount Sinai Journal of Medicine, 69(): 38-44.

Quality in Health Care
Voluntary reporting system in anaesthesia: is there a link between undesirable and critical events?
Boelle, PY; Garnerin, P; Sicard, JF; Clergue, F; Bonnet, F
Quality in Health Care, 9(4): 203-209.

Anesthesia and Analgesia
The anesthetic management of triplet cesarean delivery: A retrospective case series of maternal outcomes
Marino, T; Goudas, LC; Steinbok, V; Craigo, SD; Yarnell, RW
Anesthesia and Analgesia, 93(4): 991-995.

Acta Anaesthesiologica Scandinavica
Repeat cesarean section in a morbidly obese parturient: a new anesthetic option
Kuczkowski, KM; Benumof, JL
Acta Anaesthesiologica Scandinavica, 46(6): 753-754.

Anaesthesist
Anaesthesia for caesarean section. Comparison of two general anaesthetic regimens and spinal anaesthesia
Adams, HA; Meyer, P; Stoppa, A; Muller-Goch, A; Bayer, P; Hecker, H
Anaesthesist, 52(1): 23-32.
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West Indian Medical Journal
Anaesthesia for operative deliveries at the university hospital of the West Indies - A change of practice
Crawford-Sykes, A; Scarlett, M; Hambleton, IR; Nelson, M; Rattray, C
West Indian Medical Journal, 54(3): 187-191.

Anesthesia and Analgesia
Epidural anesthesia for elective cesarean delivery with intraoperative arterial occlusion balloon catheter placement
Fuller, AJ; Carvalho, B; Brummel, C; Riley, ET
Anesthesia and Analgesia, 102(2): 585-587.
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Journal of Clinical Anesthesia
Oral intake policies on labor and delivery: A national survey
Hawkins, JL; Gibbs, CP; Martin-Salvaj, G; Orleans, M; Beaty, B
Journal of Clinical Anesthesia, 10(6): 449-451.

Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
Recent development of obstetric regional anaesthesia in a university hospital
Standl, T; Wilhelm, S; Gnirke, A; Huneke, B
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Anaesthesia
Training in obstetric general anaesthesia: a vanishing art?
Johnson, RV; Lyons, GR; Wilson, RC; Robinson, APC
Anaesthesia, 55(2): 179-183.

British Journal of Anaesthesia
Pulmonary aspiration of gastric contents in obstetrics
Engelhardt, T; Webster, NR
British Journal of Anaesthesia, 84(3): 421.

Regional Anesthesia and Pain Medicine
Bupivacaine-sparing effect of fentanyl in spinal anesthesia for cesarean delivery
Choi, DH; Ahn, HJ; Kim, MH
Regional Anesthesia and Pain Medicine, 25(3): 240-245.

Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Anesthesia for Cesarean section in a patient with paraplegia resulting from tumour metastases to spinal cord
Jones, BP; Milliken, BC; Penning, DH
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie, 47(): 1122-1128.

Seminars in Perinatology
The Role of the Anesthesiologist in Management of Obstetric Hemorrhage
Gallos, G; Redai, I; Smiley, RM
Seminars in Perinatology, 33(2): 116-123.
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Archives of Gynecology and Obstetrics
Running an obstetric anesthesia training program: words of wisdom
Kuczkowski, KM
Archives of Gynecology and Obstetrics, 280(6): 883-888.
10.1007/s00404-009-1069-1
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Iranian Journal of Public Health
Comparison of Frequency Vaginal and Cesarean Deliveries
Karami, K; Najafian, M; Shahri, P; Faizi, S; Noorifard, Z
Iranian Journal of Public Health, 38(4): 97-102.

International Journal of Obstetric Anesthesia
General anesthesia for cesarean section: are we really prepared?
Hawkins, JL; Gibbs, CP
International Journal of Obstetric Anesthesia, 7(3): 145-146.

International Journal of Gynecology & Obstetrics
Anesthesia in pregnant women with HELLP syndrome
Vigil-De Gracia, P; Silva, S; Montufar, C; Carrol, I; De Los Rios, S
International Journal of Gynecology & Obstetrics, 74(1): 23-27.

Regional Anesthesia and Pain Medicine
Systemic toxicity and cardiotoxicity from local anesthetics: Incidence and preventive measures
Mulroy, MF
Regional Anesthesia and Pain Medicine, 27(6): 556-561.
10.1053/rapm.2002.37127
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Acta Anaesthesiologica Scandinavica
Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section
Orbach-Zinger, S; Friedman, L; Avramovich, A; Ilgiaeva, N; Orvieto, R; Sulkes, J; Eidelman, LA
Acta Anaesthesiologica Scandinavica, 50(7): 793-797.
10.1111/j.1399-6576.2006.01083.x
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Anaesthesist
Preoperative fasting 2008
Weiss, G; Jacob, M
Anaesthesist, 57(9): 857-872.
10.1007/s00101-008-1429-4
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Anesthesia and Analgesia
A Retrospective Review of 34,109 Epidural Anesthetics for Obstetric and Gynecologic Procedures at a Single Private Hospital in Turkey
Katircioglu, K; Hasegeli, L; Ibrahimhakkioglu, HF; Ulusoy, B; Damar, H
Anesthesia and Analgesia, 107(5): 1742-1745.
10.1213/ane.0b013e31817bd11f
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Anesthesia and Analgesia
Repeated Episodes of Respiratory Distress in an Obese Parturient After Cesarean Delivery
Wittels, B; Attia, TA; Al-Qamari, A; Jaycox, MP
Anesthesia and Analgesia, 108(4): 1246-1248.
10.1213/ane.0b013e3181979e01
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Anesthesia and Analgesia
Premedication with fentanyl and midazolam decreases the reliability of intravenous lidocaine test dose
Moore, JM; Liu, SS; Neal, JM
Anesthesia and Analgesia, 86(5): 1015-1017.

International Journal of Obstetric Anesthesia
Labor epidural analgesia: back to the dark ages or a potential win-win situation
Cohen, SE
International Journal of Obstetric Anesthesia, 8(4): 223-225.

Critical Care Clinics
Airway management in the obstetric patient
Lewin, SB; Cheek, TG; Deutschman, CS
Critical Care Clinics, 16(3): 505-+.

International Journal of Obstetric Anesthesia
Testing an epidural catheter in obstetrics: epinephrine or isoproterenol?
Gogarten, W; Strumper, D; Buerkle, H; Van Aken, H; Marcus, MAE
International Journal of Obstetric Anesthesia, 10(1): 40-45.

Anesthesia and Analgesia
Maternal mortality during hospital admission for delivery: A retrospective analysis using a state-maintained database
Panchal, S; Arria, AM; Labhsetwar, SA
Anesthesia and Analgesia, 93(1): 134-141.

Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing
The effect of unrestricted oral carbohydrate intake on labor progress
Tranmer, JE; Hodnett, ED; Hannah, ME; Stevens, BJ
Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing, 34(3): 319-328.
10.1177/0884217505276155
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Journal of Veterinary Emergency and Critical Care
Surgical repair of a peritoneopericardial diaphragmatic hernia in a pregnant dog
Statz, GD; Moore, KE; Murtaugh, RJ
Journal of Veterinary Emergency and Critical Care, 17(1): 77-85.
10.1111/j.1476-4431.2006.00200.x
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Journal of Anesthesia
Management of the difficult and failed airway in obstetric anesthesia
Vasdev, GM; Harrison, BA; Keegan, MT; Burkle, CM
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10.1007/s00540-007-0577-z
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Journal of Obstetrics and Gynaecology
General versus neuraxial anaesthesia for caesarean section: Impact on the duration of hospital stay
Fassoulaki, A; Petropoulos, G; Staikou, C; Siafaka, I; Sarantopoulos, C
Journal of Obstetrics and Gynaecology, 29(1): 25-30.
10.1080/01443610802628569
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Clinical and Experimental Obstetrics & Gynecology
Regional anaesthesia for primary caesarean section in patients with preterm HELLP syndrome: a review of 102 cases
Palit, S; Palit, G; Vercauteren, M; Jacquemyn, Y
Clinical and Experimental Obstetrics & Gynecology, 36(4): 230-234.

American Journal of Obstetrics and Gynecology
Anesthesia for childbirth: Controversy and change
Caton, D; Frolich, MA; Euliano, TY
American Journal of Obstetrics and Gynecology, 186(5): S25-S30.
10.1067/mob.2002.122381
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Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
Anesthesia for Sectio Coesaria with aortic dissection in Marfan syndrome
Adam, H; Radow, L
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 37(): 630-635.

Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
Anaesthesia today
Blobner, M; Kochs, E
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 38(4): 241-254.

Anesthesiology
Indications for general anesthesia during cesarean section
Hepner, DL; Tsen, LC; Harnett, M; Carabuena, JM; Camann, W; Hart, G; Kodali, BS
Anesthesiology, 100(5): B55.

Anaesthesia
Thoracic paravertebral block for breast surgery
Stamatiou, G; Athanasiou, E; Simeoforidou, M; Bakos, P; Michaloudis, D
Anaesthesia, 59(7): 723-724.

Journal of Clinical Anesthesia
An unusual presentation of idiopathic thrombocytopenic purpura in pregnancy
Ranasinghe, JS; Tjin-A-Tsoi, EW; Lewis, MC
Journal of Clinical Anesthesia, 17(1): 66-68.
10.1016/j.jclinane.2004.03.016
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Gynakologe
Anesthesia in operative delivery
Wulf, H
Gynakologe, 31(9): 786-793.

Journal of Nurse-Midwifery
Clinical bulletin no. 3 - December 1998 - Intrapartum nutrition
[Anon]
Journal of Nurse-Midwifery, 44(2): 124-128.

Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
Prophylactic measures against obstetric acid aspiration syndrome in the Federal Republic of Germany 1997. A review based on the results of a federal survey
Schneck, H; von Hundelshausen, B; Wagner, R; Scheller, M; Kochs, E
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 34(4): 204-213.

Anesthesia and Analgesia
A century of regional analgesia in obstetrics
Gogarten, W; Van Aken, H
Anesthesia and Analgesia, 91(4): 773-775.

Obstetrical & Gynecological Survey
A guest editorial: New practice guidelines for obstetric anesthesia
Mayer, DC; Spielman, FJ
Obstetrical & Gynecological Survey, 55(): 593-594.

Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
Anaesthetic techniques for caesarian section - epidural catheter anaesthesia
Bachmann-Mennenga, B; Veit, G
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 36(1): 53-57.

Archives of Gynecology and Obstetrics
Medico-legal issues in obstetric anesthesia: what does an obstetrician need to know?
Kuczkowski, KM
Archives of Gynecology and Obstetrics, 278(6): 503-505.
10.1007/s00404-008-0697-1
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Anaesthesia and Intensive Care
Analgesia after caesarean delivery
McDonnell, NJ; Keating, ML; Muchatuta, NA; Pavy, TJG; Paech, MJ
Anaesthesia and Intensive Care, 37(4): 539-551.

Regional Anesthesia and Pain Medicine
Safety During Regional Anesthesia What Do We Know and How Can We Improve Our Practice?
Benhamou, D; Auroy, Y; Amalberti, R
Regional Anesthesia and Pain Medicine, 35(1): 1-3.
10.1097/AAP.0b013e3181c99564
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Acta Anaesthesiologica Scandinavica
Anaesthetic management of high-risk obstetric patients
Schneider, MC
Acta Anaesthesiologica Scandinavica, 41(): 163-165.

Acta Anaesthesiologica Scandinavica
Intraoperative complications: Aspiration
Hackl, W; Regal, W; Lichtenberger, M; Donner, E; Strasser, K; WatzakHelmer, M
Acta Anaesthesiologica Scandinavica, 41(): 308-310.

New England Journal of Medicine
Analgesia for labor
Birnbach, DJ
New England Journal of Medicine, 337(): 1764-1766.

International Journal of Gynecology & Obstetrics
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[Anon]
International Journal of Gynecology & Obstetrics, 78(3): 321-334.

History of Anesthesia
Spinal anesthesia in severe preeclampsia: a historical analysis of a reappraisal
Wallace, DH; Giesecke, AH
History of Anesthesia, 1242(): 177-183.

Anaesthesist
Anaesthesia for caesarean section in obese women. Results from a 4-year observational period
Schulzeck, S; Gleim, M; Palm, S
Anaesthesist, 52(9): 787-794.
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Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing
Analgesia and anesthesia during labor and birth: Implications for mother and fetus
Poole, JH
Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing, 32(6): 780-793.
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11Th International Pain Clinic: World Society of Pain Clinicians
Outcome of obstetric regional anesthesia
Alon, E; Weiss, BM
11Th International Pain Clinic: World Society of Pain Clinicians, (): 5-13.

Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
Obstetric anaesthesia - Fasting in the labour room - A traditional quality standard on the test bench
Breuer, JP; Correns, I; Spies, C
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 42(3): 192-198.

The American Journal of Forensic Medicine and Pathology
Pregnancy-Associated Deaths: A 15-Year Retrospective Study and Overall Review of Maternal Pathophysiology
Christiansen, LR; Collins, KA
The American Journal of Forensic Medicine and Pathology, 27(1): 11-19.
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International Anesthesiology Clinics
Airway Management of the Parturient
Dennehy, KC; Pian-Smith, MC
International Anesthesiology Clinics, 38(3): 147-159.

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Anesthesiology
Indocyanine Green: Evidence of Neurotoxicity in Spinal Root Axons
Dietz, FB; Jaffe, RA
Anesthesiology, 98(2): 516-520.

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Anesthesiology
How Do We Measure (the Cost of) Pain Relief?
Chestnut, D
Anesthesiology, 92(3): 643.

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Anesthesiology
Mask Induction with Sevoflurane in a Parturient with Severe Tracheal Stenosis
Ratner, EF; Cohen, SE; El Sayed, Y; Druzin, M
Anesthesiology, 95(2): 553-555.

Anesthesiology
Gloved and Masked—Will Gowns Be Next?: The Role of Asepsis during Neuraxial Instrumentation
Hepner, DL
Anesthesiology, 105(2): 241-243.

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Anesthesiology
Liability Associated with Obstetric Anesthesia: A Closed Claims Analysis
Davies, JM; Posner, KL; Lee, LA; Cheney, FW; Domino, KB
Anesthesiology, 110(1): 131-139.
10.1097/ALN.0b013e318190e16a
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Anesthesiology
Heart Rate Variability Predicts Severe Hypotension after Spinal Anesthesia for Elective Cesarean Delivery
Hanss, R; Bein, B; Ledowski, T; Lehmkuhl, M; Ohnesorge, H; Scherkl, W; Steinfath, M; Scholz, J; Tonner, PH
Anesthesiology, 102(6): 1086-1093.

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Anesthesiology
A Series of Anesthesia-related Maternal Deaths in Michigan, 1985–2003
Mhyre, JM; Riesner, MN; Polley, LS; Naughton, NN
Anesthesiology, 106(6): 1096-1104.
10.1097/01.anes.0000267592.34626.6b
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Anesthesiology
Doxorubicin-induced Cardiomyopathy during Pregnancy: Three Case Reports of Anesthetic Management for Cesarean and Vaginal Delivery in Two Kyphoscoliotic Patients
Pan, PH; Moore, CH
Anesthesiology, 97(2): 513-515.

Anesthesiology
Anesthesia-related Maternal Mortality: A Pat on the Back or a Call to Arms?
D'Angelo, R
Anesthesiology, 106(6): 1082-1084.
10.1097/01.anes.0000267587.42250.29
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Anesthesiology
Analgesia for Labor Pain: A Cost Model
Macario, A; Scibetta, WC; Navarro, J; Riley, E
Anesthesiology, 92(3): 841-850.

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Anesthesiology
Obstetric Postanesthesia Care Unit Stays: Reevaluation of Discharge Criteria after Regional Anesthesia
Cohen, SE; Hamilton, CL; Riley, ET; Walker, DS; Macario, A; Halpern, JW
Anesthesiology, 89(6): 1559-1565.

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Anesthesiology
Anesthesia-related Maternal Deaths: Where Is “Regional Anesthesia”?
Mhyre, JM; Servin, MN; Polley, LS; Naughton, NN
Anesthesiology, 108(1): 171.
10.1097/01.anes.0000296644.62918.7e
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Anesthesiology
Anesthesia-related Maternal Deaths: Where Is “Regional Anesthesia”?
Kinsella, SM; Dob, D; Holdcroft, A
Anesthesiology, 108(1): 170.
10.1097/01.anes.0000296651.86043.63
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Anesthesiology
Gerard W. Ostheimer “What’s New in Obstetric Anesthesia” Lecture
Bucklin, BA
Anesthesiology, 104(4): 865-871.

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Anesthesiology
Anesthesia and Maternal Mortality
Chestnut, DH
Anesthesiology, 86(2): 273-276.

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Anesthesiology
Airway Changes during Labor and Delivery
Kodali, B; Chandrasekhar, S; Bulich, LN; Topulos, GP; Datta, S
Anesthesiology, 108(3): 357-362.
10.1097/ALN.0b013e31816452d3
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Anesthesiology
Intensive Care Utilization during Hospital Admission for Delivery : Prevalence, Risk Factors, and Outcomes in a Statewide Population
Panchal, S; Arria, AM; Harris, AP
Anesthesiology, 92(6): 1537-1544.

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Anesthesiology
Spinal Anesthesia in Severely Preeclamptic Women: When Is It Safe?
Santos, AC
Anesthesiology, 90(5): 1252-1254.

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Anesthesiology
Comparison of Metaraminol and Ephedrine Infusions for Maintaining Arterial Pressure during Spinal Anesthesia for Elective Cesarean Section
Ngan Kee, WD; Lau, TK; Khaw, KS; Lee, BB
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Changes in the Provision of Anesthesia for the Parturient Undergoing Cesarean Section
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Complications of Regional Anesthesia in Obstetrics
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The Downside of Cesarean Delivery: Short- and Long-Term Complications
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Complications of Anesthesia for Cesarean Delivery
Bloom, SL; Spong, CY; Weiner, SJ; Landon, MB; Rouse, DJ; Varner, MW; Moawad, AH; Caritis, SN; Harper, M; Wapner, RJ; Sorokin, Y; Miodovnik, M; O’Sullivan, MJ; Sibai, B; Langer, O; Gabbe, SG; for the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network,
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The Effect of Spinal Anesthesia on the Success Rate of External Cephalic Version: A Randomized Trial
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The Journal of Perinatal & Neonatal Nursing
Neuraxial Analgesia for Labor and Birth: Implications for Mother and Fetus
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Keywords:
Anesthesia; obstetric: maternal mortality; pregnancy‐related mortality; risk factors

© 1997 American Society of Anesthesiologists, Inc.

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