International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2008
Randomized Controlled TrialSpinal anesthesia with sequential administration of plain and hyperbaric bupivacaine provides satisfactory analgesia with hemodynamic stability in cesarean section.
Hypotension during spinal anesthesia is one of the major concerns in cesarean section. To achieve adequate spinal anesthesia with less hypotension, we evaluated the viability of sequential subarachnoid injection of two different baricities of bupivacaine. We used plain bupivacaine 5mg to obtain dense anesthesia of the surgical site, followed by hyperbaric bupivacaine 5mg to achieve spread to T5 anesthesia to address visceral pain. ⋯ Sequential subarachnoid injection of plain and hyperbaric bupivacaine for cesarean section can provide reliable spinal anesthesia with a lower incidence of hypotension and vomiting.
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Int J Obstet Anesth · Jul 2008
Comparative StudyComparison of an equal-dose spinal anesthetic for cesarean section and for post partum tubal ligation.
We postulated that a spinal dose of hyperbaric bupivacaine 12 mg and morphine 100 microg administered for cesarean section would yield an equivalent sensory block height and provide sufficient analgesia if administered within 48 h of delivery for postpartum tubal ligation. ⋯ An equivalent dose of hyperbaric bupivacaine 12 mg and morphine 100 microg for both CS and PPTL resulted in a higher sensory block, more hypotension and nausea in CS patients. The studied regimen might be appropriate for PPTL, but appears excessive for CS.
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Int J Obstet Anesth · Jul 2008
Case ReportsCerebral venous sinus thrombosis following accidental dural puncture and epidural blood patch.
We report the case of a woman who developed cerebral venous sinus thrombosis after an attempted epidural. The epidural was complicated by an accidental dural puncture and the ensuing headache was initially treated with an epidural blood patch. Cerebral venous sinus thrombosis is an uncommon condition with varying aetiology and risk factors. We discuss the importance of the differential diagnosis for postpartum headache and explore the relationship between cerebral venous sinus thrombosis and the triad of pregnancy, dural puncture and epidural blood patch.
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Int J Obstet Anesth · Jul 2008
Case ReportsHemorrhagic stroke following elective cesarean delivery.
We present a case of hemorrhagic stroke after cesarean delivery under combined spinal-epidural anesthesia in an 35-year-old Hispanic patient treated with anticoagulants for protein C deficiency. She required vasopressor therapy for intraoperative hypotension and developed severe headache immediately after administration. ⋯ Although the exact cause of her hemorrhagic stroke is uncertain, the hypertensive response that may have led to the hemorrhagic stroke occurred following administration of commonly used doses of vasopressor agents. We discuss the possible causes of stroke.
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Int J Obstet Anesth · Jul 2008
Case ReportsInterventional radiology in women with suspected placenta accreta undergoing caesarean section.
Placenta praevia in the presence of a previous uterine scar is associated with increased risk of placenta accreta, which could lead to major haemorrhage at delivery. Major haemorrhage is one of the leading causes of maternal mortality in the UK. Interventional radiology with trans-catheter balloon occlusion or arterial embolisation is a recognised technique for the management of intractable obstetric haemorrhage. ⋯ The obstetricians and anaesthetists in our institution are of the impression that the use of peri-operative, preferably pre-operative, internal iliac artery catheterization with or without balloon occlusion or embolisation, in women with placenta accreta or percreta, improves the operative field and potentially reduces blood loss and transfusion requirements. We were unable to find evidence that this technique reduces the need for caesarean hysterectomy. Through our experience, we have developed a unit protocol for the management of women with suspected placenta accreta undergoing caesarean section.