International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2007
Epidural analgesia for parturients with type 1 von Willebrand disease.
Epidural analgesia is usually contraindicated in von Willebrand disease. However, in type 1, the increased synthesis of von Willebrand factor (vWF) and factor VIII (FVIII:C) during pregnancy can lead to a correction of biological abnormalities and may allow epidural analgesia to be performed for delivery. ⋯ vWF and FVIII:C increased to normal values in all cases at term in these parturients with type 1 von Willebrand disease. Epidural analgesia, when performed for labor, was uncomplicated. However, platelet aggregation tests with PFA-100 unmasked unexpected, persistent abnormalities. The value of this test for clinical decision making remains to be determined by further prospective studies.
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Int J Obstet Anesth · Jul 2007
Randomized Controlled Trial Retracted PublicationA randomized study of the effects of preoperative ketorolac on general anaesthesia for caesarean section.
Ketorolac may attenuate the maternal stress response to tracheal intubation, while avoiding opioid-induced neonatal depression. We aimed to evaluate the haemodynamic and hormonal effects of prophylactic ketorolac on surgical stress and analgesia after caesarean delivery. ⋯ Prophylactic ketorolac is safe and effective in attenuating the maternal stress response to intubation and improves the quality of analgesia after caesarean delivery.
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Int J Obstet Anesth · Jul 2007
ReviewBlood conservation techniques in obstetrics: a UK perspective.
In the UK, maternal mortality due to haemorrhage appears to be rising, with obstetric haemorrhage accounting for 3-4% of the red cells transfused. Allogeneic blood transfusion carries risks such as administration errors, transmitted infections and immunological reactions. The supply of blood is decreasing, partly due to the exclusion of donors who have themselves received a blood transfusion since 1980, in order to stop transmission of variant-Creutzfeldt-Jakob disease. ⋯ Acute normovolaemic haemodilution may induce anaemia and cardiac failure and cannot be used in an emergency. It may have a limited role in combination with other techniques. Intra-operative cell salvage is more effective and useful in obstetrics than the other techniques, overcomes their shortcomings and is endorsed by CEMACH, OAA/AAGBI Guidelines, the National Blood Service and NICE.
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Int J Obstet Anesth · Jul 2007
Case ReportsCombined spinal-epidural analgesia for labor in a patient with Marfan's syndrome.
We report the management of a patient with Marfan's syndrome for labor analgesia and vaginal delivery using a combined spinal-epidural technique. The rapid onset of analgesia for the first stage of labor provided by the intrathecal opioid, combined with the slow and controlled onset of sensory anesthesia and sympathetic block provided by the dilute epidural local anesthetic, may make this technique particularly useful for labor and delivery in patients with Marfan's syndrome.
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Int J Obstet Anesth · Jul 2007
Gerard W. Ostheimer Lecture 2006: What's New in Obstetric Anaesthesia? Contributions from the 2005 literature.
The Gerard W. Ostheimer lecture is given every year at the annual meeting of the Society for Obstetric Anesthesia and Perinatology by an obstetric anaesthesiologist who has reviewed the scientific literature for the previous calendar year. This article is based on the 2006 Ostheimer lecture and reviews three areas of interest in neonatology: resuscitation of the newborn, neonatal encephalopathy and the influence of epidural analgesia on breastfeeding.