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Open Access Case Report

Emergency bedside cesarean delivery: lessons learned in teamwork and patient safety

Michelle A O Kinney13*, Carl H Rose2, Kyle D Traynor2, Eric Deutsch1, Hafsa U Memon2, Staci Tanouye2, Katherine W Arendt1 and James R Hebl1

Author Affiliations

1 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA

2 Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA

3 Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

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BMC Research Notes 2012, 5:412  doi:10.1186/1756-0500-5-412

Published: 6 August 2012

Abstract

Background

Maternal cardiovascular and pulmonary events during labor and delivery may result in adverse maternal and fetal outcome. Potential etiologies include primary cardiac events, pulmonary embolism, eclampsia, maternal hemorrhage, and adverse medication events. Remifentanil patient-controlled analgesia is an alternative when conventional neuraxial analgesia for labor is contraindicated. Although remifentanil is a commonly used analgesic, its use for labor analgesia is not clearly defined.

Case presentation

We present an unexpected and unique case of remifentanil toxicity resulting in the need for an emergent bedside cesarean delivery. A 30-year-old G3P2 woman receiving subcutaneous heparin anticoagulation due to a recent deep vein thrombosis developed cardiopulmonary arrest during labor induction due to remifentanil toxicity.

Conclusion

A rapid discussion among the attending obstetric, anesthesia, and nursing teams resulted in consensus to perform an emergent bedside cesarean delivery resulting in an excellent fetal outcome. During maternal cardiopulmonary arrest, a prompt decision to perform a bedside cesarean delivery is essential to avoid significant maternal and fetal morbidity. Under these conditions, rapid collaboration among obstetric, anesthesia, and nursing personnel, and an extensive multi-layered safety process are integral components to optimize maternal and fetal outcomes.

Keywords:
Perimortem cesarean section; Remifentanil; Pregnancy; Medication overdose