As an anesthesiologist, I found myself intrigued by this article. Although confidently hailed as a new nonfatal case of amniotic embolism, the sequence of events and findings could perhaps also have resulted from aspiration of regurgitated gastric contents at the time of delivery. Many patients under spinal anesthesia become distressed at this time from the presence of blood and amniotic fluid in the upper abdomen, under the diaphragm, and may become nauseated. Pressure on the fundus during a section delivery may be a contributory factor in gastric regurgitation. Aspiration of gastric contents in the waking patient under spinal anesthesia is not unknown and warrants more serious consideration than its dismissal in one sentence on page 992. The possibility always deserves to be weighed clinically since hydrocortisone parenterally may be a valuable therapeutic adjunct.
The significance of the usually contraindicated sequence of ephedrine followed by ergonovine appears to have escaped the