International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 1998
Operative obstetric mortality at Harare Central Hospital 1992-1994: an anaesthetic view.
A prospective review of anaesthetic-associated deaths (AAD) was undertaken at the maternity unit of Harare Central Hospital, Zimbabwe, for the triennium 1992-1994. AAD was defined as death within 24 h of anaesthesia or failure to regain consciousness. Three groups of avoidable factors (obstetric, anaesthetic and administrative) were considered, and a scoring system used to allocate one avoidability point for each death with avoidable factors. ⋯ The problems are discussed and also viewed in the context of overall maternal mortality (outcome period 42 days). The mortality data are compared with those from the UK and some hospitals in South Africa. It is concluded that improvements in resources, education, guidelines and monitoring are necessary if the mortality rate is to be reduced.
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We report the anaesthetic management of a primiparous patient presenting in late pregnancy with rapidly progressive bitemporal hemianopia due to a pituitary mass caused by autoimmune hypophysitis. Caesarean section was complicated by post-partum haemorrhage. Anaesthesia is discussed together with a review of the literature on lymphocytic hypophysitis.
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Int J Obstet Anesth · Oct 1998
Acute airway obstruction during spinal anaesthesia for caesarean section.
A 30-year-old primiparous Caucasian woman with known placenta praevia required an emergency caesarean section for a mild antepartum haemorrhage at the onset of spontaneous term labour. Following intravenous prehydration with 500 ml gelatin colloid (Haemaccel trade mark ), spinal anaesthesia was induced in the sitting position with 2.6 ml of 0.5% hyperbaric bupivacaine (13 mg). The patient was then placed in the recumbent position with left lateral tilt, whereupon she suddenly became dyspnoeic. ⋯ Since parturients have a higher incidence of difficult airway management than the general population, anaphylactoid reactions presenting as angioneurotic oedema pose a particular challenge for the anaesthetist. The lower incidence of allergy associated with hydroxyethyl starch (Hetastarch) may make it a more appropriate choice of colloid in this setting. However, the balance of evidence now suggests that vasopressors, particularly ephedrine, are superior to fluids for maintenance of blood pressure during regional anaesthesia for caesarean section.
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Int J Obstet Anesth · Oct 1998
Cardiovascular consequences of the concomitant administration of nifedipine and magnesium sulfate in pigs.
There is concern regarding the interaction of magnesium sulfate and nifedipine used concomitantly in obstetrical patients, because both are calcium channel antagonists and may induce myocardial depression as well as peripheral vasodilatation. The objective of this study was to determine the hemodynamic consequences of concomitant administration of nifedipine and magnesium sulfate in anesthetized pigs. Twelve pigs were anesthetized with sodium pentobarbital, intubated mechanically ventilated. ⋯ Treatment with calcium chloride or ephedrine was only partially successful in improving myocardial contractility. Phenylephrine increased peripheral vascular resistance and MAP, but did not improve myocardial function. In conclusion, the depressive effects of nifedipine and magnesium sulfate on the cardiovascular system are potentiated when administered concomitantly.