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Anesth Analg 2006;103:1330
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000242325.23959.16

LETTER TO THE EDITOR

Editor-in-Chief Steven L. Shafer

Anesthesia for Interventional Radiology in Parturients at Risk of Major Hemorrhage at Cesarean Section Delivery

Andrea J. Fuller, MD, Brendan Carvalho, FRCA, Catherine Brummel, MD, and Edward T. Riley, MD

Department of Anesthesia; Stanford University; Stanford, California; Colorado Permanente Medical Group; Denver, Colorado; andisamf{at}msn.com

In Response:

In our case series we stated, "After epidural placement, interventional radiologists placed internal iliac artery occlusion balloon catheters (IIAOBC) via the femoral arteries using fluoroscopic guidance and angiographic confirmation" (1). We agree with the letter from Drs. Harnett, Carabuena, Tsen, and Kodali (2) that the epidural should be placed before the intraarterial balloon occlusion catheter, and we concur with their reasons.

However, we prefer to perform the surgery in the operating room rather than in the interventional radiology suite, which is not an ideal environment to perform a surgery potentially complicated by major blood loss, a difficult obstetric airway, and neonatal complications. The larger size of an operating room and the availability of personnel and equipment is preferable should a major maternal hemorrhage or airway emergency occur. We agree that the interventional radiologists should visualize major contributing and collateral vessels prior to surgery. At our institution this visualization, fluoroscopic guidance, and angiographic confirmation are performed in the operating room by the interventional radiology team.

Drs. Harnett, Carabuena, Tsen, and Kodali have much experience with this procedure, and we appreciate their comments. The specifics of each case, including the benefits of performing the surgical procedure in the operating room versus the interventional radiology suite, will vary among institutions. In our article we outlined several general principles critical to ensuring optimal maternal and neonatal outcomes: early recognition of women at risk for major hemorrhage, anticipation of a potentially difficult airway, careful planning of the procedure, and communication among the various specialties.

REFERENCES

  1. Fuller AJ, Carvalho B, Brummel C, Riley ET. Epidural anesthesia for elective cesarean delivery with intraoperative arterial occlusion balloon catheter placement. Anesth Analg 2006;102:585–7.[Abstract/Free Full Text]
  2. Harnett MJP, Carabuena JM, Tsen LC, Kodali BS. Anesthesia for interventional radiology in parturients at risk of major hemorrhage at cesarean section delivery. Anesth Analg 2006;103:1330.[Free Full Text]



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A. J. Fuller, B. Carvalho, C. Brummel, and E. T. Riley
Anesthesia for Interventional Radiology in Parturients at Risk of Major Hemorrhage at Cesarean Section Delivery
Anesth. Analg., November 1, 2006; 103(5): 1330 - 1330.
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press