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Present and emerging strategies for reducing anesthesia-related maternal morbidity and mortality

Arendt, Katherine Wa; Segal, Scottb

Current Opinion in Anesthesiology: June 2009 - Volume 22 - Issue 3 - p 330–335
doi: 10.1097/ACO.0b013e3283298746
Obstetric and gynecological anesthesia: Edited by Marc Van de Velde

Purpose of review As the demographic of pregnant women continues to change, anesthesiologists will need to continue to find new ways to prevent morbidity and mortality. In this article several new and emerging strategies to meet this challenge are discussed.

Recent findings Emergence and recovery are now the most common times for airway loss. The proportion of liability claims involving neuraxial anesthesia have increased. Ultrasound can assist in spinal or epidural anesthesia. The most effective antiseptic is 0.5% chlorhexidine in 80% ethanol, which is generally accepted for use in neuraxial techniques. An animal study indicates that bupivacaine-induced cardiac arrest is more effectively treated by intravenous lipid emulsion than by epinephrine. In obstetric hemorrhage, consideration should be given to 1: 1 FFP: PRBC transfusion, and in severe cases, rFVIIa.

Summary Over the past 50 years, the field of anesthesiology has reduced the rates of anesthesia-related maternal mortality and major morbidity considerably. As the obstetric demographic becomes older and more obese, new technologies and strategies can assist in keeping maternal death and major morbidity vanishingly rare.

aDepartment of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA

bDepartment of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

Correspondence to Katherine W. Arendt, MD, Mayo Clinic, Department of Anesthesiology, 200 First Street SW, Rochester, MN 55902, USA Tel: +1 507 284 9694; fax: +1 507 284 0120; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.