Current opinion in anaesthesiology
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Haemorrhage remains a cause of significant maternal morbidity and mortality. This review summarizes the prevention, management and treatment of obstetric haemorrhage and highlights recent advances and developments. ⋯ Accurate diagnosis and appropriate management of obstetric haemorrhage can reduce maternal morbidity and mortality. This review outlines the current evidence.
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To look at different anesthetic approaches to different surgical techniques used in fetal procedures and the influence of maternal and fetal factors on anesthetic management. ⋯ Open fetal surgery remains a major invasive procedure for mother and fetus both, requiring general anesthesia with adequate invasive monitoring. Minimal invasive fetal procedures can be performed with local anesthesia alone or, for the more complex fetoscopic procedures, with a neuraxial locoregional technique. Fetal anesthesia and analgesia can then be provided by different routes. Ex-utero intrapartum treatment procedures are open fetal procedures, but they can be performed with locoregional anesthesia, when uterine relaxation can be achieved without volatile anesthetics with the use of intravenous nitroglycerin.
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Curr Opin Anaesthesiol · Jun 2008
ReviewNeurological complications following central neuraxial blockades in obstetrics.
The last few decades have seen an increased use of central neuraxial blockades in obstetric patients. Central blockades provide excellent labour analgesia and safe anaesthesia for caesarean section associated with low incidence of severe complications. Therefore, an increasing number of blockades are also performed in women affected by significant disease. The risks and benefits of central blockades, however, might differ in these patients. This review addresses the risks of neurological complications following central neuraxial blockades in healthy parturients as well as in women affected by significant haemostatic and neurological disease. ⋯ Estimation of the incidence of neurological complications following central neuraxial blockades to women affected by significant disease on the basis of case reports and small series of patients is impossible. Prospective registration of high-risk patients may increase our knowledge. Application of central neuraxial blockade must follow individual evaluation.
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Nitrous oxide has been used in clinical practice for over 150 years, often for pediatric procedures. Not only are there problems when used in patients with a variety of inborn errors of metabolism, but effects of nitrous oxide on the developing human brain are unknown. ⋯ There is a growing body of evidence that supports avoidance of nitrous oxide in both pediatric and adult patients, but the thousands of patients who have been exposed to nitrous oxide without apparent complications would suggest that further studies on long-term side effects and possible neurologic consequences need to be done.
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Clinical practices in oxygen administration are in need of change based on the increasing understanding of oxygen toxicity. Hypoxemia is due to many pathophysiological causes; avoiding hypoxemia is an important objective during neonatal anesthesia. Nevertheless, the only known cause for hyperoxemia is the excess and unnecessary administration of oxygen by healthcare providers. To avoid hyperoxemia is an important objective during neonatal anesthesia. ⋯ Even brief neonatal exposures to pure oxygen must be avoided during neonatal anesthesia. When any dose of supplemental oxygen is given, a reliable pulse oximeter aiming to avoid hyperoxemia is necessary. Even though further research is essential, administration of oxygen by healthcare providers when it is not necessary is a foe and a neonatal health hazard.