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To the Editor:—
As long as emergencies, as described in the ANESTHESIA PROBLEM OF THE MONTH (207:1903, 1969) are handled as ineptly as this one was, I suspect that The Journal will be able to carry this feature for many months to come.A sensory level of T-4 after a spinal anesthetic indicates that it was the major cause of the hypotension, and did more than possibly "enhance" the effect of the gravid uterus. And as long as this complication is treated as tardily and inadequately, I can understand the temptation to look for more exotic causes. That the pressure rose after the delivery of the child might be proof that caval compression occurred, but it might also indicate that oxytocics were given, too.Oxygen by mask should be started immediately, not 15 minutes, after the start of a spinal anesthetic, especially after a high level of anesthesia, and
Carter A. A Problem in Anesthesiology. JAMA. 1969;208(13):2476. doi:10.1001/jama.1969.03160130060023