interesting

[urge]

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Members don't see this ad.

"in the UK problems with tracheal intubation during obstetric general anesthesia remain the leading cause of death"

The Confidential Enquiries into Maternal and Child Health. Why Mothers Die 2000-2002. The Sixth Report on the Confidential Enquiries into Maternal Deaths in the United Kingdom. London, RCOG Press. 2004


Dedicated to all the guys who were using the UK experience as an example of how GA was safe in the parturient.

 

[proman]

The real question is how does American obstetric GA morbidity and mortality compare to American non-obstetric EMERGENCY GA.

 

[Gas]

I hope you mean this is the most common anesthetic related-death. Most common cause of death is still hemorrhage worldwide - British women bleed the same as American ones.

I don't think anyone has said emergency GA in a parturient is as safe as GA in non-parturients, emergency or not. There is an increase in the incidence of difficult intubations compared to the general population - we all know that, and we also know all the anatomic/physiologic problems making GA in a parturient less desirable than regional. I do think the dangers are hyped up more than they should be in academics, and others have stated that. Is there hard data comparing morbidity and mortality which favors one or the other? No, or this would not be controversial.

When emergencies like this occur, you do whatever you can and what you think is the best for the mom as a first priority. However, fetal bradycardia should also be taken into consideration, and you have to use your judgement as a physician to make the call.

 

[militarymd]

"in the UK problems with tracheal intubation during obstetric general anesthesia remain the leading cause of death"

The Confidential Enquiries into Maternal and Child Health. Why Mothers Die 2000-2002. The Sixth Report on the Confidential Enquiries into Maternal Deaths in the United Kingdom. London, RCOG Press. 2004


Dedicated to all the guys who were using the UK experience as an example of how GA was safe in the parturient.

that's no surprise.

if you look at our closed claims project...the leading cause of death from GA (in all populations)...is...you guessed it....difficulty with the airway.

someone correct me if I'm wrong.

 

[militarymd]

I hope you mean this is the most common anesthetic related-death. Most common cause of death is still hemorrhage worldwide - British women bleed the same as American ones.

I don't think anyone has said emergency GA in a parturient is as safe as GA in non-parturients, emergency or not. There is an increase in the incidence of difficult intubations compared to the general population - we all know that, and we also know all the anatomic/physiologic problems making GA in a parturient less desirable than regional. I do think the dangers are hyped up more than they should be in academics, and others have stated that. Is there hard data comparing morbidity and mortality which favors one or the other? No, or this would not be controversial.

When emergencies like this occur, you do whatever you can and what you think is the best for the mom as a first priority. However, fetal bradycardia should also be taken into consideration, and you have to use your judgement as a physician to make the call.

probably no worse than the fat osa guy with a beard.

 

[urge]

Is there hard data comparing morbidity and mortality which favors one or the other? No, or this would not be controversial.

A quick google search answers your question. I wouldn't consider it "hard" but if you have "hard" numbers disproving this, feel free to share. Don't worry I won't hold my breath.

"the mortality rate was 17 per million general anesthetics most recently!" vs 3 per million regional.

http://www.cja-jca.org/cgi/content/full/49/suppl_1/R6

There is no controversy. Only in this forum have I heard that GA is ok. The evidence being that the British are doing it.

I just wanted to make everyone aware of how the Brits are doing- Not too good.

 

[militarymd]

A quick google search answers your question. I wouldn't consider it "hard" but if you have "hard" numbers disproving this, feel free to share. Don't worry I won't hold my breath.

"the mortality rate was 17 per million general anesthetics most recently!" vs 3 per million regional.

http://www.cja-jca.org/cgi/content/full/49/suppl_1/R6

There is no controversy. Only in this forum have I heard that GA is ok. The evidence being that the British are doing it.

I just wanted to make everyone aware of how the Brits are doing- Not too good.

You are mis-quoting a number of things:

1) I mentioned Germany, not UK
2) the reports mention that loss of Airway is the leading cause of GA deaths in OB patients....that's true in Non-OB patients

3) here's the BIG one...the data that EVERYONE quotes comparing mortality rates in Obstetric patient populations is based on a...now hold your breath....BIASED patient selection.


When do we do GA for C-sections.......when it's an emergency.

When do we do Regional for C-sections....when we have time...


Why do we do that?.....because it's the lore...we've been taught to do that since we were born...including me....


OK...now the smart academics go and look at ALL the cases and compare mortality....(OVERALL EXTREMELY LOW>>a few per million)....and conclude that GA is 5 times more dangerous.....

How about this conclusion.....Emergency C-sections are 5X more likely to kill a parturient than Non-Emergency C-sections.

Take it anyway you want....the smart guys believe one thing based on the data....dumb guys like me just look at the data and somehow just CANNOT arrive at the magical conclusions that the smart guys arrive at.

 

[militarymd]

What? No rebuttals???

 

[samneeru]

hello

i ma looking for results on decompression craniectomy in intracerebral hemorrhage

thank you

Dr. Sam