Intraoperative Death During Caesarian Section in a Patient with Sickle-cell Trait. The Anaesthesia Advisory Committee to the Chief Coroner of Ontario

The case of a woman with sickle cell trait who sustained a cardiac arrest and died during a Caesarian section under general anaesthesia is reported. Because the common causes of intraoperative hypoxia and shock were ruled out in this case, we believe that death was due to severe concealed aorto-caval compression. After delivery, the release of a large volume of hypoxaemic, acidotic blood with sickled cells could cause cardiac depression and arrest. The fact that the patient's mucous membranes were pink and she was haemodynamically stable while her uterus was cyanotic prior to delivery provides some positive evidence for this hypothesis. We emphasize that while complications secondary to sickle cell trait during general anaesthesia are very rare, they can occur. We discuss methods of monitoring such patients.