Anesthetic considerations in pregnant women at advanced maternal age.

J Matern Fetal Neonatal Med. 2014 Apr 9. 

Orbach-Zinger S, Aviram A, Ioscovich A, Listengart M, Reuveni A, Fein S, Eidelman LA, Yogev Y.

Anesthesia management of parturients aged 45 years and above is comparable to the management of women aged 40-44 years. However, parturients ≥45 are more susceptible to

bleeding complications. 

Of note, parturients aged ≥ 45 years had an approximately eight-fold risk for postpartum hemorrhage.

Effects of a head elevated ramped position during elective caesarean delivery after combined spinal-epidural anaesthesia.

Cheesman K, Massey S, Preston R, Albert A, Douglas J.

Int J Obstet Anesth.     2014 May;23(2):106-12.

Elevating the parturient undergoing elective caesarean delivery into the Head Elevated Ramped Position immediately or once the block had been established did not appear to significantly alter time to an adequate block height of T4; however, the need for epidural supplementation was greater in the intervention groups. Cautious use of this novel position change can provide a more comfortable experience and provide a better airway position should conversion to general anaesthesia be required.

Survival after an amniotic fluid embolism following the use of sodium bicarbonate.

Evans S, Brown B, Mathieson M, Tay S


BMJ Case Rep. 2014 May 30;2014

We present a case of a 38-year-old mother admitted for an elective caesarean section. Following the delivery of her baby, the mother suffered a cardiac arrest. Following a protracted resuscitation, transoesophageal echocardiography demonstrated evidence of acute pulmonary hypertension, with an empty left ventricle and an over-distended right ventricle. In view of these findings and no improvement noted from on-going resuscitation, sodium bicarbonate was infused as a pulmonary vasodilator. Almost instantaneous return of spontaneous circulation was noted, with normalisation of cardiac parameters. We propose that in patients suspected with AFE and who have been unresponsive to advance cardiac life support measures, and where right ventricular failure is present with acidosis and/or hypercarbia, the use of sodium bicarbonate should be considered.