Transcutaneous Electrical Nerve Stimulation at the PC-5 and PC-6 Acupoints Reduced the Severity of Hypotension After Spinal Anesthesia in Patients Undergoing Cesarean Section

Abstract

fluids and supplemental therapy appear to be a better approach in women with HEG unresponsive to medical management.COMMENT This is one of those papers that should make each of us as anesthesiologists sit up and take notice. Although, the topic might not catch our attention at first glance, I believe it has deeper implications for all our patients during the perioperative period. The recent availability of PICC line services at many institutions seemed like a dream come true. In many patients with issues of difficult access or for the convenience of longterm therapy this seemed a simple cure. At our institution, we have become familiar with and have requested this service on many occasions. Alas, as with pulmonary artery catheters and coronary stent procedures there may be a dark side. This paper takes what many of us would consider a standard therapy of PICC placement in hyperemesis and makes us think long and hard about risks. As discussed above, the authors found striking increases in maternal complications in the PICC line group. What makes this even more alarming is the types of complications; including things like bacteremia, sepsis, and thrombosis.These complications also led in several cases to intensive care unit admissions and further aggressive therapeutic interventions. The authors accurately point out that even though fetal outcomes were not significantly different, there were more NICU admissions in the PICC line group (9.1% vs. 4.7% and 0%) and 2 of these women had bacteremia associated with their indwelling PICC lines. In addition, these authors are not alone in their observations of elevated complication rates in association with PICC lines and point this out in their discussion by summarizing several other studies. 1-3 One study in pregnant patients found a 50% complication rate associated with PICC line placement. 1 Once again, we are reminded to be wary and carefully utilize new therapies while constantly monitoring the potential downsides.