Emergent inter-hospital, direct operating room-to-operating room transport of an anesthetized patient: A case report and discussion

A 37-year-old healthy woman developed an intraoperative complication while undergoing a laparoscopic-assisted vaginal hysterectomy at a Women and Children's Hospital. Her external iliac artery was nicked, requiring emergent repair consisting of lateral wall suture-ligation to control hemorrhage. The artery was suture-ligated, and the patient was stabilized. The patient was then transferred under anesthesia to a nearby hospital equipped with a surgical intensive care unit and in-house vascular surgeon for comprehensive repair of the iliac artery. In preparation for transport, EMS was contacted, and the patient was given midazolam 2 mg IV and rocuronium 40 mg IV. An infusion of propofol 75 mcg/kg/min was administered under the supervision of an anesthesiology resident who remained with the patient during transport, and a portable mechanical ventilator provided by EMS was utilized. Standard ASA monitors were used throughout the ambulance transfer. In addition to standard emergency drugs, 2 units of packed red blood cells (pRBC), additional anesthetics (rocuronium, propofol & fentanyl), a laryngoscope and blades, an i-STAT® handheld blood analyzer, and a warming blanket were taken for transport. The patient was moved directly to the operating room upon arrival to the receiving hospital.