International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2004
Comment Letter Case ReportsInadequate spinal anaesthesia with 0.5% Marcain Heavy (Batch 2016).
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Int J Obstet Anesth · Apr 2004
Comparative Study Clinical TrialDoes pregnancy increase the efficacy of lumbar epidural anesthesia?
Pregnancy has been reported to enhance the sensitivity of nerves to local anesthetics and to decrease anesthetic requirements during regional anesthesia. In this study, whether pregnancy increased the efficacy of lumbar epidural anesthesia was evaluated. Two populations (14 pregnant and 14 non-pregnant women) undergoing lumbar epidural anesthesia were studied and received 17 mL of 2% lidocaine-epinephrine (1: 200,000). ⋯ In pregnant women, cephalad spread of epidural anesthesia was facilitated but latency of blockade, density and motor blockade were not. It takes over 25 min to achieve satisfactory blockade at sacral segments. Those who perform lumbar epidural anesthesia alone for cesarean section should consider the use of additives (e.g. fentanyl, bicarbonate) to enhance the block, or a greater volume of local anesthetic.
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We conducted a retrospective review of obstetric patients admitted to the intensive care unit at Al-Ain hospital during period January 1(st) 1997 to December 31(st) 2002, in order to identify the indications for admission and the outcome. A total of 60 patients were admitted during the six years. The frequency of admission was 2.6 per 1000 deliveries and obstetric patients represented 2.4% of all ICU admissions. ⋯ The mean APACHE II score and duration of stay were significantly higher in these patients. There were two deaths, representing 3.3% of obstetric intensive care unit admissions. Our findings highlight the need for establishing a high dependency unit to avoid unnecessary admission to the intensive care unit and to ensure proper management.
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Int J Obstet Anesth · Apr 2004
Comparative StudyIn vitro evidence of gender-related heparin resistance.
Coagulability varies among men, women, and pregnant women, along a spectrum where the blood of men is the least and that of pregnant women the most coagulable. The effects of differences in coagulation status on the action of heparin cannot be measured by specific laboratory tests such as aPTT or anti-Factor Xa assay. Thromboelastography which measures whole blood coagulation can assess the effect of heparin against differing backgrounds of coagulation. ⋯ Across the subject groups, from men to pregnant women, increasing coagulability was seen, with shortening of r and k (P < 0.04), and increasing angle and MA (P < 0.0001). A relationship between gender and heparin was significant for r and k (P < 0.02) but not for angle and MA. This result assists the case against a one-size-fits-all approach to policies on heparinisation.