title: [A case of cardiac arrest at induction of anesthesia for postpartum hysterectomy].
abstract: Although peripartum cardiac arrest is rare, the prognosis of the event may be worse than in nonpregnant patients because the events is often associated with pulmonary or amniotic embolisms. The following report is a case of cardiac arrest which occurred at the induction of anesthesia for the postpartum hysterectomy. A 31-year-old woman was treated with infusion of ritodrine chloride for preterm labor and placenta previa. Elective cesarean section was performed at 37 weeks' gestation for her delivery under epidural anesthesia. Following the operation, the total hysterectomy was scheduled due to the continuous massive bleeding. She rapidly developed ventricular tachycardia, following trachea intubation with propofol and suxamethonium. Since she was not resuscitated with cardiac massage, we started intravenous epinephrine, electronic cardioversion, the percutaneous cardiopulmonary support and intra-aortic balloon pumping with epinephrine and dopamine infusions leading to a successfully outcome. In this case, we believe that the combination of propofol and suxamethonium had the most impact on producing the cardiac arrest. Therefore, the case emphasizes the potential danger of using these combination for patients who have been treated with ritodrine.
authors.affiliation: Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara 228-8555.
authors.forename: Makiko
authors.initials: M
authors.lastname: Hashiba
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Okutomi
authors.forename: Katsu
authors.initials: K
authors.lastname: Saito
authors.forename: Kan
authors.initials: K
authors.lastname: Amano
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Okamoto
authors.forename: Sumio
authors.initials: S
authors.lastname: Hoka
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000009:adverse effects*; D002585:Cesarean Section; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007044:Hysterectomy; D007431:Intraoperative Complications / Q000209:etiology* / Q000628:therapy; D010923:Placenta Previa; D011183:Postoperative Complications / Q000139:chemically induced / Q000601:surgery; D049590:Postpartum Period; D011247:Pregnancy; D015742:Propofol / Q000009:adverse effects; D012086:Reoperation; D012312:Ritodrine / Q000009:adverse effects; D013390:Succinylcholine / Q000009:adverse effects; D015149:Tocolytic Agents / Q000009:adverse effects; D014592:Uterine Hemorrhage / Q000139:chemically induced / Q000601:surgery
chemical_list: D015149:Tocolytic Agents; D012312:Ritodrine; D013390:Succinylcholine; D015742:Propofol