International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 1996
Carotid artery puncture, airway obstruction and the laryngeal mask airway in a preeclamptic patient.
We report a case of a preeclamptic patient with a difficult airway in whom attempted central venous cannulation led to inadvertent carotid artery puncture and dilatation causing immediate life threatening upper airway obstruction. The use of the laryngeal mask airway was life-saving on two occasions when other techniques of airway management had failed. We discuss the series of events that led to this critical incident and suggest areas in which management might have been improved.
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Int J Obstet Anesth · Jul 1996
The anaesthetic management of intracranial haemorrhage from arteriovenous malformations during pregnancy: three cases.
We report three cases of intracranial haemorrhage from arteriovenous malformations during pregnancy. The anaesthetic management of the pregnant patient undergoing a major neurosurgical procedure and the anaesthetic management of caesarean section in a patient at risk of recurrent intracranial haemorrhage are discussed.
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Int J Obstet Anesth · Jul 1996
Randomized Controlled Trial Clinical TrialThromboembolic deterrent stockings fail to prevent hypotension associated with spinal anaesthesia for elective caesarean section.
This study was carried out to determine whether the use of thrombo-embolic deterrent (TED) stockings, in combination with an intravenous crystalloid preload, would prevent hypotension following spinal anaesthesia for caesarean section. Fifty parturients undergoing elective caesarean section under spinal anaesthesia were randomly allocated into two groups. TED stockings were applied to the study group 1 h before spinal anaesthesia but none were applied to the control group. ⋯ Significant hypotension, defined as an absolute value of systolic arterial pressure (SAP) of less than 90 mmHg and a decrease of more than 20% from baseline SAP was treated with 3 mg bolus of ephedrine as required. The difference in SAO between the two groups was not statistically significant. In the control group, 80% of parturients required ephedrine as opposed to 56% in the TED group; a difference that was also not statistically significant.
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Routine orogastric aspiration of stomach contents during general anaesthesia for caesarean section was recommended in the latest triennial report on maternal deaths. We conducted a postal survey which revealed that the majority of obstetric units do not follow this guideline. ⋯ Despite routine antacid prophylaxis, a large proportion of our emergency patients remain at risk for aspiration pneumonia. We thus concur with the recommendation that the stomach should be aspirated during general anaesthesia for emergency caesarean section.