International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2007
Review Case ReportsAnaesthesia for caesarean section in a woman with lung cancer: case report and review.
A 33-year-old woman pregnant with twins was diagnosed with metastatic lung cancer during pregnancy. Her multidisciplinary care raised many medical and ethical issues. To help decide on the best anaesthetic technique for caesarean section, a literature search of published case reports of pregnancy associated with lung cancer was performed. ⋯ Anaesthetic technique was reported in only five of the 20 patients who underwent caesarean section: one spinal, three epidurals and one general anaesthetic. Of the 11 patients who delivered vaginally, only one was reported to have received epidural analgesia. As published data regarding anaesthesia and analgesia are limited for women with lung cancer in pregnancy, we describe our perioperative approach and review the potential challenging aspects of management in a pregnant patient with metastatic lung cancer.
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Int J Obstet Anesth · Jan 2007
Randomized Controlled Trial Comparative StudyA randomized trial of crystalloid versus colloid solution for prevention of hypotension during spinal or low-dose combined spinal-epidural anesthesia for elective cesarean delivery.
Spinal anesthesia for cesarean delivery is commonly associated with hypotension and nausea and vomiting, and preload with crystalloid or colloid solution is widely recommended. Low-dose spinal via the combined spinal-epidural technique appears to cause less hypotension and nausea and vomiting. The aim of this study was to investigate whether the combined use of colloid preload and combined spinal-epidural technique might further reduce the rates of these symptoms. ⋯ Colloid preload and low-dose spinal anesthesia alone or in combination lowered the incidences of hypotension and nausea. However, the combination of two methods failed to demonstrate further decreases in the incidence of the symptoms compared to the colloid-spinal anesthesia or crystalloid-combined spinal-epidural anesthesia groups.
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Int J Obstet Anesth · Jan 2007
Post dural puncture headache in obstetric patients: experience from a West African teaching hospital.
This prospective, non-randomised study examined the frequency and severity of post dural puncture headache in 96 Ghanaian women who consented to spinal anaesthesia for caesarean section at the Korle Bu Teaching Hospital, Accra, Ghana. ⋯ In view of the high incidence of headache and the need for treatment associated with the use of the 22-gauge Quincke needle, we recommend that this should not be used in the obstetric population. We are also aware that the incidence of post dural puncture headache could be further reduced by the use of small calibre pencil-point needles but these are currently very expensive and many obstetric units in developing countries may not be able to afford them.
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Sensitization to latex seems to occur more frequently in women than in men. Obstetric and gynecological surgical procedures have recently been shown to be a common setting for latex anaphylaxis. We analyzed all the cases of anaphylactic reactions during 1240 cesarean sections in 2004; the patients were questioned for risk factors and underwent allergy testing for drugs and latex. ⋯ If latex allergy is confirmed or strongly suspected, patients should be managed in a latex-safe environment. Premedication with antihistamines and steroids might be useful to further reduce the risk. After the delivery, specific desensitization may represent a good therapeutic option.
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Int J Obstet Anesth · Jan 2007
Comment Letter Case ReportsAnaesthetic management for caesarean section in moyamoya disease.