Cardiac Output Assessed by Invasive and Minimally Invasive Techniques

Cardiac output (CO) measurement has long been considered essential to the assessment and guidance of therapeutic decisions in critically ill patients and for patients undergoing certain high-risk surgeries. Despite controversies, complications and inherent errors in measurement, pulmonary artery catheter (PAC) continuous and intermittent bolus techniques of CO measurement continue to be the gold standard. Newer techniques provide less invasive alternatives; however, currently available monitors are unable to provide central circulation pressures or true mixed venous saturations. Esophageal Doppler and pulse contour monitors can predict fluid responsiveness and have been shown to decrease postoperative morbidity. Many minimally invasive techniques continue to suffer from decreased accuracy and reliability under periods of hemodynamic instability, and so few have reached the level of interchangeability with the PAC

Complete heart block in pregnancy: case report, analysis, and review of anesthetic management

Maternal complete heart block can pose significant challenges for the anesthesiologist in the antepartum, peripartum, and postpartum periods. Some patients may present for the first time in the puerperium with dizziness, weakness, syncope, or congestive heart failure as a result of the additional hemodynamic burden that accompanies pregnancy. Although there is an increase in permanent pacemaker placement in young symptomatic patients before pregnancy, prophylactic placement of pacemakers in asymptomatic parturients is not always indicated. The need for temporary or permanent pacemakers in asymptomatic women should be assessed on a case-by-case basis; many of these patients may be safely managed during labor and delivery without pacing. The parturient with complete heart block must be followed vigilantly during pregnancy and post delivery, as the need for pacemaker insertion can also arise in the postpartum period. We present a case of third-degree heart block in a 26-year-old parturient

Ebola virus disease in pregnancy and anesthetic considerations

Ebola virus disease (EVD) is often lethal, mortality rates range from 50% to over 90%, depending on the patient population, viral strain, and access to medical care. During pregnancy, the morbidity and mortality from the viral disease has been suggested to be among the highest of any affected patient population. According to the existing literature, which is confined to a few small case series in Africa, the risk of spontaneous fetal loss is high and there have been no known neonatal survivors. The mode of EVD transmission is well understood and evidence from the current and previous epidemics indicates that transmission can be interrupted by infection control measures. The central element of providing care to a patient suspected of Ebola is a three-step triage process: identify/isolate/inform. Once the diagnosis is confirmed, because of the potentially worse outcomes seen in pregnancy, specialized multidisciplinary care may be needed. In addition, especially in the obstetric setting, there is a high likelihood of exposure to a potentially deadly disease by health care workers. Therefore, these patients should be managed by anesthetic and obstetric providers in centers with expertise, protocols and training. Labor pain management, and the decision to proceed with cesarean delivery or other obstetric interventions will need to be considered on a case-by-case basis, weighing the risks and benefits to the mother, the fetus and the caregivers