title: Severe maternal bradycardia and asystole after combined spinal-epidural labor analgesia in a morbidly obese parturient.
abstract: Serious maternal bradycardia and asystole in laboring parturients after combined spinal-epidural labor analgesia are rare. We report such a case in a morbidly obese laboring parturient after receiving combined spinal-epidural labor analgesia. The differential diagnosis, risk factors, potential contributing factors, and the successful management of the complications with our positive patient outcome are discussed. Even with the low dose of neuraxial drugs commonly administered in combined spinal-epidural labor analgesia, this case underscores the importance of vigilance, frequent monitoring, proper positioning, and rapid resuscitation with escalating doses of ephedrine, atropine, and epinephrine, all of which are essential in the presence of bradycardia or asystole in these patients.
authors.affiliation: Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1009, USA. ppan@wfubmc.edu
authors.forename: Peter H
authors.initials: PH
authors.lastname: Pan
authors.forename: Charles H
authors.initials: CH
authors.lastname: Moore
authors.forename: Vernon H
authors.initials: VH
authors.lastname: Ross
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001919:Bradycardia / Q000139:chemically induced*; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced*; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy; D007743:Labor, Obstetric; D009765:Obesity / Q000150:complications*; D007744:Obstetric Labor Complications / Q000209:etiology*; D011247:Pregnancy