In Reply:—
We thank Kinsella et al. for their excellent comments. Our case series did include three women who suffered catastrophic complications after regional anesthesia for cesarean delivery.1The mechanism of death in each of these cases was unique. One patient developed high spinal from an inadvertent intrathecal pharmacologic test dose during epidural catheter placement. Despite prompt and successful conversion to general anesthesia, she experienced massive myocardial infarction. Another died from neuraxial cardiac arrest following spinal anesthesia, with cardiovascular collapse preceding delivery of her neonate. The third patient became apneic en route to the postanesthesia care unit after a spinal anesthetic supplemented with intravenous medications.
Regional anesthesia may be safer than general anesthesia,2,3but respiratory arrest or cardiovascular collapse may still occur1–4*during induction, maintenance, or recovery. Skills in basic airway management and cardiopulmonary resuscitation are essential for the entire team of perioperative care providers, regardless of whether the patient receives general or regional anesthesia.
†University of Michigan Health System, Women’s Hospital, Ann Arbor, Michigan. jmmhyre@umich.edu
