International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2008
Case ReportsThe hemodynamics of oxytocin and other vasoactive agents during neuraxial anesthesia for cesarean delivery: findings in six cases.
Oxytocin is a commonly used uterotonic that can cause significant and even fatal hypotension, particularly when given as a bolus. The resulting hypotension can be produced by a decrease in systemic vascular resistance or cardiac output through a decrease in venous return. Parturients with normal volume status, heart valves and pulmonary vasculature most often respond to this hypotension with a compensatory increase in heart rate and stroke volume. ⋯ Pulse power analysis was conducted in six cases of cesarean delivery performed under neuraxial anesthesia. Hypotension in response to oxytocin was associated with a decrease in systemic vascular resistance and a compensatory increase in stroke volume, heart rate and cardiac output. Pulse power analysis may be helpful in determining the etiology of and treating hypotension during cesarean delivery under neuraxial anesthesia.
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Int J Obstet Anesth · Jul 2008
Randomized Controlled Trial Comparative StudyEstimation of the minimum motor blocking potency ratio for intrathecal bupivacaine and lidocaine.
The up-down sequential allocation model has been adapted to investigate a variety of clinical and pharmacological issues in neuraxial anaesthesia including the estimation of relative potency ratios for analgesia and motor block of the most commonly used epidural and intrathecal local anaesthetics. The aim of this study was to establish the median effective doses (ED50) for motor block with intrathecal lidocaine and bupivacaine and to define the relative motor blocking potency ratio. ⋯ Intrathecal bupivacaine was 4.1 times more potent than lidocaine for motor block.
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Int J Obstet Anesth · Jul 2008
Comparative StudyVanishing experience in training for obstetric general anaesthesia: an observational study.
Changes in the delivery of anaesthesia for caesarean section have meant that trainee experience in obstetric general anaesthesia has steadily declined. In the UK, working patterns for trainees have changed significantly with the introduction of the New Deal in 2000 and the European Working Time Directive in 2004. Because of an impression that training opportunities had worsened during this period we have reviewed data in obstetric general anaesthesia at St James's University Hospital since 1998. ⋯ Since 1998 training opportunities in general anaesthesia for caesarean section at St James's Hospital have continued to decline. This reflects both changing trends in the delivery of anaesthesia for caesarean section and also changes in training hours and trainee numbers.
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Int J Obstet Anesth · Jul 2008
Randomized Controlled Trial Multicenter StudyVaginal twin delivery: a survey and review of location, anesthesia coverage and interventions.
Twin pregnancies are associated with increased perinatal morbidity and mortality. No consensus exists whether vaginal twin delivery should take place in the labor room or operating room, or whether anesthesiologists should be present. We surveyed members of the California Society of Anesthesiologists (CSA) to review management of vaginal twin delivery, and examined anesthetic intervention retrospectively at our institution. ⋯ There is a lack of consensus regarding the appropriate location for vaginal twin delivery and the role of anesthesiologists. A significant percentage of women undergoing vaginal twin delivery in our institution received anesthetic intervention in the immediate delivery period.
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Int J Obstet Anesth · Jul 2008
Multicenter StudyA survey of labour ward clinicians' knowledge of maternal cardiac arrest and resuscitation.
Guidelines for the management of cardiac arrest during pregnancy exist but they are based on little research. The study hypothesis was that experienced medical clinicians who specialise in obstetric care would not follow current International Liaison Committee on Resuscitation/American Heart Association recommendations in this situation. ⋯ Specialist clinicians who treat pregnant women in hospital on a daily basis possess a limited knowledge of the recommendations for treating maternal cardiac arrest.