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Anesthesiology:
doi: 10.1097/01.anes.0000296644.62918.7e
Correspondence

Anesthesia-related Maternal Deaths: Where Is “Regional Anesthesia”?

Mhyre, Jill M. M.D.†; Servin, Monica N. Riesner M.D.; Polley, Linda S. M.D.; Naughton, Norah N. M.D., M.B.A.

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In Reply:—

We thank Kinsella et al. for their excellent comments. Our case series did include three women who suffered catastrophic complications after regional anesthesia for cesarean delivery.1 The mechanism of death in each of these cases was unique. One patient developed high spinal from an inadvertent intrathecal pharmacologic test dose during epidural catheter placement. Despite prompt and successful conversion to general anesthesia, she experienced massive myocardial infarction. Another died from neuraxial cardiac arrest following spinal anesthesia, with cardiovascular collapse preceding delivery of her neonate. The third patient became apneic en route to the postanesthesia care unit after a spinal anesthetic supplemented with intravenous medications.
Regional anesthesia may be safer than general anesthesia,2,3 but respiratory arrest or cardiovascular collapse may still occur1–4* during induction, maintenance, or recovery. Skills in basic airway management and cardiopulmonary resuscitation are essential for the entire team of perioperative care providers, regardless of whether the patient receives general or regional anesthesia.
Jill M. Mhyre, M.D.,†
Monica N. Riesner Servin, M.D.
Linda S. Polley, M.D.
Norah N. Naughton, M.D., M.B.A.
†University of Michigan Health System, Women’s Hospital, Ann Arbor, Michigan. jmmhyre@umich.edu
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References

1. Mhyre JM, Riesner MN, Polley LS, Naughton NN: A series of anesthesia-related maternal deaths in Michigan, 1985-2003. Anesthesiology 2007; 106:1096–104

2. The Confidential Enquiries into Maternal and Child Health. Why Mothers Die 2000-2002. The Sixth Report on the Confidential Enquiries into Maternal Deaths in the United Kingdom. London, RCOG Press. 2004

3. Hawkins JL, Koonin LM, Palmer SK, Gibbs CP: Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990. Anesthesiology 1997; 86:277–84

4. Kinsella SM, Dob D, Holdcroft A: Regional Anesthesia. In: Crises in Childbirth - Why Mothers Survive. Lessons from the Confidential Enquiries into Maternal Deaths. Edited by Dob D, Cooper G, Holdcroft A. Radcliffe Publishing Ltd., Oxford, 2007

* See also Lofsky S: Anesthesia-related maternal arrests on labor and delivery. Available at: www.thedoctors.com. Accessed September 6, 2007. Cited Here...

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