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pearl
1
Perimortem cesarean section is a heroic intervention that may be beneficial in maternal arrest, though is unlikely to do further harm.
Katz V, Balderston K, DeFreest M. Perimortem cesarean delivery: were our assumptions correct? Am. J. Obstet. Gynecol. 2005 Jun 1;192(6):1916-20; discussion 1920-1.
  Daniel Jolley
summary
1
A review of all published perimortem cesarean section case reports by Vern Katz, following up his article in 1986 first recommending this procedure.
While this does not offer proof of benefit (huge survival selection bias), of the 38 cases reported, 34 neonates survived (includes multiple gestations), and of the 20 cases with reversible causes, 13 mothers were discharged from hospital.
Katz writes:
In 12 of 18 reports that documented hemodynamic status, cesarean delivery preceded return of maternal pulse and blood pressure, often in a dramatic fashion. Eight other cases noted improvement in maternal status. Importantly, in no case was there deterioration of the maternal condition with the cesarean delivery.
Katz V, Balderston K, DeFreest M. Perimortem cesarean delivery: were our assumptions correct? Am. J. Obstet. Gynecol. 2005 Jun 1;192(6):1916-20; discussion 1920-1.
  Daniel Jolley
summary
1
The first published case of a successful perimortem cesarean section with good neurological outcome for both mother and baby.
DePace NL, Betesh JS, Kotler MN. 'Postmortem' cesarean section with recovery of both mother and offspring. JAMA. 1982 Aug 27;248(8):971-3.
  Daniel Jolley
summary
1
This is the first published recommendation for perimortem cesarean sections in maternal cardiac arrest – from Katz, Dotters and Droegemueller (1986).
It was this recommendation that lead to the ‘4 minute rule’ for deciding to commence a CS in a resuscitation scenario, with the aim of delivering the baby within 5 minutes.
Katz VL, Dotters DJ, Droegemueller W. Perimortem cesarean delivery. Obstet Gynecol. 1986 Oct 1;68(4):571-6.
  Daniel Jolley
summary
0
McDonnell makes a concerning observation regarding the ageing maternity population and subsequent potential for increasing rates of maternal arrest:
With the change in the obstetric population characteristic to women being older, heavier, and having more complex medical problems during pregnancy, the number of women who become seriously unwell while pregnant is likely to increase.
McDonnell NJ. Cardiopulmonary arrest in pregnancy: two case reports of successful outcomes in association with perimortem Caesarean delivery. Br J Anaesth. 2009 Sep 1;103(3):406-9.
  Daniel Jolley
summary
1
McDonnell highlights the differences in managing the collapsed parturient, namely:
• Need to prevent aortocaval compression.
• Early securing of the airway.
• Rapid perimortem Caesarean delivery.
• Likelihood of a non-cardiac/pregnancy cause.
The two cases presented include arrest due to ruptured uterus and arrest possibly due to iatrogenic magnesium overdose. Both resulted in favorable, though not perfect, outcomes for mother and baby.
The need for delivery suite ‘perimortem cesarean section packs’ is also discussed, as well as the use of regular simulation training.
McDonnell NJ. Cardiopulmonary arrest in pregnancy: two case reports of successful outcomes in association with perimortem Caesarean delivery. Br J Anaesth. 2009 Sep 1;103(3):406-9.
  Daniel Jolley
pearl
1
Anesthesia with nitrous oxide preserves awake features of the EEG leading to inappropriately higher BIS values.
Foster BL Liley DT. Nitrous oxide paradoxically modulates slow electroencephalogram oscillations: implications for anesthesia monitoring. Anesth. Analg. 2011 Oct 1;113(4):758-65.
  Daniel Jolley
pearl
1
Propofol and thiopentone are physiochemically compatible when mixed.
Prankerd RJ Jones RD. Physicochemical compatibility of propofol with thiopental sodium. Am J Health Syst Pharm. 1996 Nov 1;53(21):2606-10.
  Daniel Jolley
pearl
1
Video-laryngoscopy in pediatric anesthesia improves glottis visualization but prolongs intubation time and increases failure.
Sun Y, Lu Y, Huang Y et al. Pediatric video laryngoscope versus direct laryngoscope: a meta-analysis of randomized controlled trials. Paediatr Anaesth. 2014 Oct 1; 24 (10): 1056-65.
  Daniel Jolley
pearl
1
The addition of ketamine to lignocaine-based IVRA (Bier's block) significantly improved analgesia and patient satisfaction without increasing side effects.
Abdel-Ghaffar HS, Kalefa MA, Imbaby AS. Efficacy of Ketamine as an Adjunct to Lidocaine in Intravenous Regional Anesthesia. Reg Anesth Pain Med. 2014 Sep 1; 39 (5): 418-22.
  Daniel Jolley