International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1998
Anaesthetic management of a parturient with severe congenital factor XI deficiency undergoing caesarean section for triplet pregnancy.
The report describes the anaesthetic management of a Jewish patient of Ashkenazi descent with severe factor XI deficiency complicated by thrombocytopenia for caesarean section for triplets at the 35th week of gestation. Perioperative management consisted of sustained replacement therapy with fresh frozen plasma and platelets until the sixth postoperative day. General anaesthesia was used for the procedure. No other maternal or neonatal complications occurred.
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Int J Obstet Anesth · Jan 1998
Convulsions in a healthy parturient due to intrapartum water intoxication.
Water intoxication during pregnancy is an uncommon event, usually associated with iatrogenic fluid overload, the prolonged administration of high doses of oxytocin or psychiatric disorder. This case report describes water intoxication presenting as the sudden onset of grand mal convulsions in the immediate postpartum period, after a normal delivery in a healthy parturient. The most likely explanation was an excessive voluntary ingestion of large quantities of water and hypotonic fluids during labour.
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Int J Obstet Anesth · Jan 1998
Cough stress rib fractures in two obstetric patients: case report and pathophysiology.
The clinical presentation of fractured ribs and physiology of cough in two obstetric patients are described to explain why a rib fracture, not a pneumothorax, occurred on coughing in these patients. At total lung capacity the outward expansion of the lower thorax (flare) during a cough is limited. ⋯ A direct expiratory action of abdominal muscles predominates over their indirect inspiratory action. The lower ribs are pulled down by the cough and may even fracture from the enormous intrapleural cough pressures which are generated before the glottis opens.
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Int J Obstet Anesth · Jan 1998
Complications of obstetric epidural analgesia and anaesthesia: a prospective analysis of 10,995 cases.
Although epidural anaesthesia and analgesia are widely used in obstetrics, there are no large contemporary prospective series detailing associated complications. Prospective data was collected on all obstetric epidural blocks performed for labour and delivery in a single institution between July 1989 and August 1994. A data entry sheet was compiled and entered onto a computer database. ⋯ There was no major local anaesthetic toxicity or neurological deficit. The incidence of potentially life-threatening morbidity was thus 0.02% although in both cases outcome was good. The only persisting complication was neurological, an apparent epidural catheter-induced traumatic mononeuropathy.
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Int J Obstet Anesth · Jan 1998
Randomized Controlled Trial Clinical TrialAnaesthesia for caesarean delivery: low-dose epidural bupivacaine plus fentanyl.
To determine the acceptability of epidural bupivacaine-induced sixth thoracic (T6) sensory blockade and the analgesic efficacy of epidural fentanyl 50 microg, 24 parturients undergoing elective caesarean section were given a test dose of lidocaine 60 mg plus epinephrine followed by 10 ml of either 0.5 % bupivacaine (control group) or 0.5 % bupivacaine plus 50 microg fentanyl (fentanyl group) in a randomized double-blind manner. Fifteen minutes later loss of pinprick sensation was determined. Additional local anaesthetic was titrated to achieve T6 sensory blockade. ⋯ The incidence of side-effects was unaffected by treatment group. Apgar scores were similar in the two groups. We conclude that following administration of 10-15 ml 0.5% bupivacaine plus fentanyl 50 microg, T6 sensory blockade is associated with good intraoperative analgesia without obvious maternal or neonatal respiratory depression.