International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2015
Introduction of enhanced recovery for elective caesarean section enabling next day discharge: a tertiary centre experience.
The widespread adoption of enhanced recovery programmes in various surgical specialties has resulted in patient benefits including reduced morbidity, reduced length of stay and an earlier return to normal activities. This evidence, along with the increased financial pressures in the UK National Health Service, has led many units to consider introducing such a programme for obstetric surgery. We report our experience in setting up an enhanced recovery programme for women undergoing elective caesarean section and a prospective analysis of factors that influence length of stay. ⋯ An enhanced recovery programme was successfully introduced into our unit. Many of the interventions were straightforward and could be adopted easily elsewhere.
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Haemorrhage is one of the commonest causes of maternal critical care admission. Cell salvage used during caesarean section can contribute to a reduction in allogeneic blood consumption. This study sought to provide a practical method to salvage blood lost after vaginal delivery and a description of the constituents before and after washing. ⋯ Vaginal blood can be collected efficiently with little disruption to patient management. The amounts of haemolysis and washout of non-red cell blood components are consistent with results in our cell salvage quality assurance programme for caesarean section and non-obstetric surgery. Although bacteria are detectable in all the post-wash and post-filter samples, the median residual contamination is similar to that found with cell salvage in caesarean section, and if re-infused would result in a circulating bacteraemia of <1 cfu/mL; this is similar to that seen with dental procedures (0.3-4.0 cfu/mL) and is thought to be clinically insignificant.
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Anaphylaxis during pregnancy is rare but life threatening to both mother and fetus. The anaesthetist may be unexpectedly faced with an obstructing airway, severe bronchospasm and cardiac arrest requiring perimortem caesarean delivery to relieve aortocaval compression. We present a case of anaphylaxis-induced hyperfibrinolysis, an infrequently discussed complication that could exacerbate postpartum haemorrhage and hamper resuscitative efforts.