Page 52 - Part 2 Anesthesiology Common Risk Issues

SVMIC Anesthesiology: Common Risk Issues

hemorrhages, severe placental abruptions, and the like, general

anesthesia may very well be the best option for anesthesia
given the severity of the complications and the risks involved in

neutralizing and resolving the complications.

Where the patient is not experiencing maternal bradycardia
and has an uncomplicated pregnancy, phenylephrine may

be selected because of improved fetal acid-base outcomes.
Additionally, various degrees of maternal hypotension before,

during, and after delivery may be relieved with the use leg
wrapping, compression stockings, and maternal positioning, all

of which are ordinary and common interventions. Even when all
best practices are used in maternal patients, emergencies occur.

The ASA mandates that hospitals and institutions providing
obstetric care “should have resources available to manage

hemorrhagic emergencies, including, but not limited to, large-
bore IC catheters, fluid warmer, forced-air body warmer, blood

bank resources, massive transfusion protocol, equipment for
infusing IV fluids and blood products rapidly, such as hand-

squeezed fluid chamber, hand-inflated pressure bags and
automatic infusion devices.”

Additionally, type-specific or O-negative blood resources are
acceptable and should be accessible. However, where there is

the presence of intractable hemorrhage, when banked blood
is not available or banked blood is refused by the patient,

intraoperative cell salvage should be considered when or if
available.

In the event of an airway emergency in the maternal patient,

labor and delivery units should have personnel and equipment
readily available to manage airway emergencies consistent with

the ASA Practice Guidelines for Management of the Difficult

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