Journal of clinical anesthesia
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Pregnancy carries substantial maternal and fetal risks in patients with uncorrected or palliatively corrected cyanotic congenital heart disease (CHD). In tricuspid valve Ebstein's anomaly, pregnancy is well tolerated. Maternal mortality in tetralogy of Fallot seems to be less than 10%, but it exceeds 50% in Eisenmenger's syndrome and primary pulmonary hypertension (PPH). ⋯ Prevention of excessive erythrocytosis, volume and blood loss substitution, cardiocirculatory pharmacologic support, prophylaxis of infective endocarditis, and judicious use of anticoagulant drugs should be applied as indicated by the type and presentation of CHD. Poor outcome of pregnancy in PPH requires an early consideration of heart-lung or lung transplantation. Multidisciplinary team effort and prolonged monitoring in the intensive care unit are mandatory to ensure a favorable outcome for cyanotic CHD and PPH parturients.
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Comparative Study
Computerized patient anesthesia records: less time and better quality than manually produced anesthesia records.
To compare manual and computerized anesthesia information management systems (AIMS's) with respect to time demands on the anesthetist and record quality. ⋯ The concern that the introduction of computerized AIMS's may complicate the anesthesia working environment by requiring more time than manual AIMS's and thus detracting from direct patient care is not supported by this study. In fact, this computer approach not only required less time but also produced a more complete and higher-quality record than did the manual AIMS.
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Case Reports
General anesthesia for cesarean section in a parturient with a single ventricle and pulmonary atresia.
The successful management of a cesarean section in a parturient with a single ventricle and pulmonary atresia using general anesthesia is discussed. After cyanosis at birth, the patient underwent cardiac catheterization, which showed an apparent severe tetralogy of Fallot, atresia of the main pulmonary artery (PA), and a large patent ductus arteriosus. When she was 7 months of age, a Blalock-Taussig shunt (right subclavian artery to right PA) was done. ⋯ The patient was then taken to the operating room electively, and an opioid-based general anesthetic was administered. Both mother and infant did well. This case is presented because the physiology of the patient's lesion and her unusual social history presented challenges for her anesthetic management.