International journal of obstetric anesthesia
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This is a retrospective record of the analgesic management during labour of 16 patients with spina bifida seen at Leicester Royal Infirmary Maternity Hospital between March 1994 and February 1996. The information highlights the potential difficulties in providing epidural analgesia for this patient group, and demonstrates how an antenatal pre-anaesthetic clinic can help to optimize pain management by providing the opportunity to formulate a realistic analgesic plan, which can be documented in the notes.
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Int J Obstet Anesth · Apr 1998
Complete recovery after near-fatal venous air embolism during cesarean section.
During replacement to the abdomen of the exteriorized uterus at cesarean section under epidural block, a previously healthy woman developed cardiorespiratory arrest. Tracheal intubation revealed low end-tidal carbon dioxide concentration suggesting embolization. Resuscitative efforts were successful. Uterine exteriorization - as well as the Trendelenburg position - significantly increase the risk of air embolization so that routine use of appropriate monitors is indicated to facilitate early diagnosis.
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Int J Obstet Anesth · Apr 1998
Neonatal effects of patient-controlled analgesia using fentanyl in labor.
Patient-controlled analgesia (PCA) has been used at our institution for the past 5 years, as an alternative labor analgesic when epidural analgesia is contraindicated. This retrospective study evaluates the effects of maternal PCA fentanyl on infants of greater than 32 weeks gestational age. The neonatal charts (n=32) were reviewed for birth weight, gestational age, 1 min and 5 min Apgar scores, use of naloxone and umbilical venous gases. ⋯ Three infants with a 1 min Apgar of 4 required naloxone. The total fentanyl received by mothers of infants who required naloxone was significantly higher than the group of mothers whose infants did not require naloxone (770 +/- 233 microg vs 298 +/- 287 microg, P = 0.027) Use of PCA fentanyl in this high-risk obstetric population was associated with a 44% incidence of moderately depressed neonates with an Apgar score
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Int J Obstet Anesth · Apr 1998
Severe urticaria and pregnancy: use of the Internet to aid management.
A case of severe urticaria complicating pregnancy is described. Advice was sought and received from experts in the condition, using the Internet to exchange information. Epsilon-aminocaproic acid (EACA) was used with no apparent adverse effects. This case report highlights some of the problems of management of thi rare condition in pregnancy and obstetric anaesthesia, and the potential benefit of the Internet and its user groups.