Category: Obstetrics

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Airway Case Studies Clinical Tips Leadership in Emergencies Obstetrics

#28 Can’t Intubate, Can’t Oxygenate (CICO) during stat C-section: a case study with Eric Carlson, CRNA

This podcast was originally published on March 1, 2015.

In this episode Kristin Lowrance, MSN, CRNA talks with Eric Carlson, CRNA about a case where he was called for a stat Cesarean section and after a rapid sequence induction, he could not intubate or oxygenate the patient. The case was at 2AM and Eric was the only anesthesia provider in house. The other on-call anesthesia provider was at least 20-minutes away. Eric walks us through what happened next and how they proceeded with the decision to simultaneously rescue the baby and perform an emergency percutaneous cricothyrotomy, followed by surgical cricothyrotomy.

Kristin and Eric talk about the decision making and challenges involved in this case and advice for other anesthesia providers when it comes to emergency airway management. It’s a harrowing story that had lasting impacts on everyone involved in the case. It’s a story of leadership in emergencies, profoundly difficult decision making and an example of why we should train for failed airways in our day-to-day, week-to-week work lives: we have to be ready when disaster strikes.

I recently caught back up with Eric following his retirement from anesthesia. In episode 29 of Anesthesia Guidebook, the podcast that follows this one, Eric reflects back on both this case and the impact that telling this story had on his own life and career. We will also talk about retirement, take a look back over his career and hit on advice he would give to anesthesia providers who are still in the thick of it. Be sure to check the next episode out to hear more from Eric!

Below are links to key resources for difficult airway management.

The Vortex Approach – real-time airway crisis cognitive aids.

Chrimes, N., Bradley, W. P. L., Gatward, J. J., & Weatherall, A. D. (2019). Human factors and the ‘next generation’airway trolley. https://doi.org/10.1111/anae.14543

Difficult Airway Society

American Society of Anesthesiologist’s Difficult Airway Guidelines

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Clinical Tips Enhanced Recovery After Surgery Obstetrics Pharmacology

#16 – Ondansetron for preventing spinal-induced hypotension with Jenny Li, BSN, SRNA

In this episode, I talk with Jenny Li, BSN, SRNA about using pre-procedural ondansetron to prevent spinal-induced hypotension in elective cesarean-sections. Ms Li is completing her Doctorate of Nursing Practice (DNP) at the University at Buffalo and structured her doctoral work around this topic. She received a Bachelor of Science in Psychology from University of California, Davis in 2013 and went back to school for a second Bachelor’s in Nursing at the University of Rochester. She worked in the Cardiovascular ICU at Strong Memorial Hospital in Rochester, NY for 2 years before returning to school to complete her Doctor of Nursing Practice degree. She is expected to graduate in May 2021.

Resources:

Gao, L., Zheng, G., Han, J., Wang, Y., & Zheng, J. (2015). Effects of prophylactic ondansetron on spinal anesthesia-induced hypotension: a meta-analysis. International journal of obstetric anesthesia, 24(4), 335-343. . https://doi.org/10.1016/j.ijoa.2015.08.012

Heesen, M., Klimek, M., Hoeks, S. E., & Rossaint, R. (2016). Prevention of spinal anesthesia-induced hypotension during cesarean delivery by 5-hydroxytryptamine-3 receptor antagonists: a systematic review and meta-analysis and meta-regression. Anesthesia & Analgesia, 123(4), 977-988.

Karacaer, F., Biricik, E., Ünal, İ., Büyükkurt, S., & Ünlügenç, H. (2018). Does prophylactic ondansetron reduce norepinephrine consumption in patients undergoing cesarean section with spinal anesthesia?. Journal of anesthesia, 32(1), 90-97.

Kinsella, S. M., Carvalho, B., Dyer, R. A., Fernando, R., McDonnell, N., Mercier, F. J., … & Consensus Statement Collaborators. (2018). International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Obstetric Anesthesia Digest, 38(4), 171-172.

Ortiz-Gómez, J. R., Palacio-Abizanda, F. J., Morillas-Ramirez, F., Fornet-Ruiz, I., Lorenzo-Jiménez, A., & Bermejo-Albares, M. L. (2017). Reducing by 50% the incidence of maternal hypotension during elective caesarean delivery under spinal anesthesia: Effect of prophylactic ondansetron and/or continuous infusion of phenylephrine-a double-blind, randomized, placebo controlled trial. Saudi journal of anaesthesia, 11(4), 408.

Šklebar, I., Bujas, T., & Habek, D. (2019). Spinal Anaesthesia-induced Hypotension in Obstetrics: Prevention and Therapy. Acta Clinica Croatica, 58(Suppl 1), 90.

Tatikonda, C. M., Rajappa, G. C., Rath, P., Abbas, M., Madhapura, V. S., & Gopal, N. V. (2019). Effect of intravenous ondansetron on spinal anesthesia-induced hypotension and bradycardia: A randomized controlled double-blinded study. Anesthesia, Essays and Researches, 13(2), 340.

Trabelsi, W., Romdhani, C., Elaskri, H., Sammoud, W., Bensalah, M., Labbene, I., & Ferjani, M. (2015). Effect of ondansetron on the occurrence of hypotension and on neonatal parameters during spinal anesthesia for elective caesarean section: a prospective, randomized, controlled, double-blind study. Anesthesiology research and practice, 2015.

Tubog, T. D., Kane, T. D., & Pugh, M. A. (2017). Effects of ondansetron on attenuating spinal anesthesia-induced hypotension and bradycardia in obstetric and nonobstetric subjects: a systematic review and meta-analysis. AANA J, 85(2), 113-122.

Zhou, C., Zhu, Y., Bao, Z., Wang, X., & Liu, Q. (2018). Efficacy of ondansetron for spinal anesthesia during cesarean section: a meta-analysis of randomized trials. Journal of International Medical Research, 46(2), 654-662.

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