Deputy Head of the Department of Anesthesiology and Intensive Care Medicine, Faculty Hospital Motol, Praha, Czech Republic
Member of Expert Committee of Labor Anesthesia and Analgesia of the Czech Society of Anesthesiology and Intensive Care Medicine
Amniotic fluid embolism (AFE) is a rare obstetric complication, one of the most dreaded, allied with mortality more then 80%. This pathological condition more than embolism reminds anaphylaxis. Actually used term is anaphylactoid syndrome in pregnancy. This learning algorithm shows very well how important it is to quickly recognise this critical condition. Conclusively, AFE is diagnosed post mortem. In practice, we use the clinical symptoms and follow the process of elimination - diagnosis per exlusionem. The algorithm shows the importance of cooperation of obstetrician, anesthesiologist and haematologist . There are capturing the main goal of therapy - oxygenation, maintaining cardiac output and blood pressure, treatment of coagulopathy. When a women in labour is basically stabilized, she is transfered to urgent Caesarean section if she had not delivered yet. Consequently, it is pointed out the importance of continuing intensive care for surviving women after managing the acute phase. I find out an information about follow-up, because many countries lack registers.
I consider this algorithm very accurate and successful, dealing with one of many critical conditions in obstetrics. The quick assessment of diagnosis and immediate start of treatment is the best result for survival of mothers.
Anaesthesia during pregnancy is not very common, so it is very good to recall and practice the procedure. It is always an acute event, such as trauma or acute abdomen. Elective surgery is not routinely performed during pregnancy.
This algorithm shows how to proceed correctly from receiving care of a patient with an acute abdomen, not to underestimate serious symptoms and whether to decide for surgery despite ongoing pregnancy. It is important how to perform an induction to anaesthesia, anaesthesia management, how to deal with possible complications and the right choice for sufficient postoperative analgesia. All these procedures - crush introduction, preoxygenation, general anaesthesia always with intubation, sufficient analgesia and others are well shown in the algorithm.
I wish to all the least frequent anesthesias during pregnancy, however there is no need to worry if the right course is followed. And as we see on this nicely created algorithm, anesthesia can be safe for both mother and fetus.