Operating rooms are not the only location where patients undergo anesthesia. For example, cardiac catheterization, neuroangiography, and MRI imaging are necessarily performed in specialized rooms equipped with advanced imaging equipment. However, these rooms can be constructed to facilitate provision of general anesthesia and open surgery, should that be prove necessary.
Dr. Allison Clark, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA and colleagues describe patients who underwent Cesarean delivery with an increased risk of hemorrhage, cardiovascular disease or intracranial pathology who were cared for in a hybrid imaging – general surgery operating room. Their experience is described in the article “Cesarean Delivery in the Hybrid Operating Suite: A Promising New Location for High-Risk Obstetric Procedures” published in this month’s edition of Anesthesia & Analgesia.
Eleven patients are described in their review. For seven, the hybrid operating room was used because of the risk of hemorrhage: placenta accreta, complete accreta in a Jehovah’s Witness, one with an ovarian cyst. Two of the patients had cardiac disease that might require cardiac catheterization: severe aortic stenosis and newly diagnosed type B aortic dissection. Two patients had neurologic reasons to be cared for in the hybrid operating room: one had a ruptured arteriovenous malformation and another had a cerebellar mass with obstructive hydrocephalus. The five patients with suspected placenta accreta underwent a range of prophylactic interventions from no intervention to placement of ureteral stents and internal iliac artery catheters. Both patients who underwent internal iliac artery catheter placement required uterine artery embolization. The patients with cardiac issues required no additional support. After delivery, the patient with a ruptured arteriovenous malformation underwent craniectomy and hematoma evacuation. The patient with the cerebellar mass underwent ventricular drain placement prior to Cesarean delivery.
Hybrid operating rooms such as the one at BWH allow two procedures to be performed in one location. They are expensive to construct. They are constructed in the operating rooms to facilitate merging of two healthcare teams without physically moving the patient. In this example, the staff who otherwise work in the labor and delivery area worked in the hybrid operating room to perform the Cesarean section. This type of setup is undoubtedly safer than transporting a potentially unstable patient from one area to another. This is the first report that describes the use of hybrid imaging – operating rooms for obstetrics.