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LETTERS TO EDITOR
Year : 2021  |  Volume : 15  |  Issue : 2  |  Page : 236-237

Ultrasound-guided SUCCESS approach in emergency cesarean delivery

Yuji Kamimura, Toshiyuki Nakanishi, Kazuya Sobue, Motoshi Tanaka
Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan

Correspondence Address:
Yuji Kamimura
Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya - 467-8601
Japan

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/sja.sja_1124_20

Date of Submission18-Nov-2020Date of Acceptance19-Nov-2020Date of Web Publication01-Apr-2021  

How to cite this article:
Kamimura Y, Nakanishi T, Sobue K, Tanaka M. Ultrasound-guided SUCCESS approach in emergency cesarean delivery. Saudi J Anaesth 2021;15:236-7
How to cite this URL:
Kamimura Y, Nakanishi T, Sobue K, Tanaka M. Ultrasound-guided SUCCESS approach in emergency cesarean delivery. Saudi J Anaesth [serial online] 2021 [cited 2021 Dec 5];15:236-7. Available from: https://www.saudija.org/text.asp?2021/15/2/236/312956

To the Editor,

We herein recommend a systematic evaluation and treatment protocol using point-of-care ultrasound (PoCUS) in the cesarean delivery setting. PoCUS has been developed and effectively used to manage obstetric anesthesia.[1] In emergency cesarean delivery, in particular, PoCUS can be crucial due to the paucity of preoperative assessments; however, to our knowledge, the PoCUS protocol in this particular setting has not been described.

We propose the ultrasound-guided “SUCCESS” approach [Figure 1]. Spinal anesthesia is the gold standard for cases without any contraindications or the need for immediate delivery. First, we should use a low-frequency convex transducer and evaluate the spine (S) structure as spinal anesthesia is sometimes difficult in patients undergoing emergency surgery. Second, even if spinal anesthesia seems feasible, we should be prepared for emergency transition to general anesthesia. PoCUS enables the assessment of the risk of needing general anesthesia by evaluating the upper abdomen (U) (gastric contents), cricothyroid membrane, (C) and cardiac function (C). PoCUS can assess the presence of gastric contents,[2] predict airway difficulty, and identify the cricothyroid membrane during the induction of anesthesia.[3],[4] The assessment of known cardiac disease or exclusion of peripartum cardiomyopathy can also be included under “C”. We should use convex, linear, and phased array probes and select the best anesthetic method by these evaluations. If general anesthesia is induced using rapid sequence intubation, we can then perform ultrasound-guided endotracheal intubation (E) and Selick's maneuver (S) to reliably occlude the esophagus.[5] Finally, in cases of massive bleeding, we should secure (S) arterial and peripheral venous access under ultrasound guidance.

In summary, we introduced the ultrasound-guided SUCCESS approach. Ultrasound equipment with multiple probes should be kept beside during an emergency cesarean delivery. By implementing “visualized” anesthesia, we can avoid preventable complications and facilitate smooth and safe anesthesia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.Zieleskiewicz L, Bouvet L, Einav S, Duclos G, Leone M. Diagnostic point-of-care ultrasound: Applications in obstetric anaesthetic management. Anaesthesia 2018;73:1265-79.  
    2.Van de Putte P, Perlas A. Ultrasound assessment of gastric content and volume. Br J Anaesth 2014;113:12-22.  
    3.Kristensen MS, Teoh WH, Rudolph SS. Ultrasonographic identification of the cricothyroid membrane: Best evidence, techniques, and clinical impact. Br J Anaesth 2016;117(Suppl 1):i39-48.  
    4.Alessandri F, Antenucci G, Piervincenzi E, Buonopane C, Bellucci R, Andreoli C, et al. Ultrasound as a new tool in the assessment of airway difficulties. Eur J Anaesthesiol 2019;36:509-15.  
    5.Byas-Smith M, Prinsell JR Jr. Ultrasound-guided esophageal occlusion during rapid sequence induction. Can J Anaesth 2013;60:327-8.  
    
  [Figure 1]