International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2011
Randomized Controlled TrialHemodynamic effects of a right lumbar-pelvic wedge during spinal anesthesia for cesarean section.
Aortocaval compression is a major cause of maternal hypotension. A randomized controlled trial was designed to determine the effectiveness of a mechanical intervention using a right lumbar-pelvic wedge in preventing hypotension after spinal anesthesia for cesarean delivery. ⋯ In our study population the use of right lumbar-pelvic wedge was not effective in reducing the incidence of hypotension during spinal anesthesia for cesarean section. Patients in whom the wedge was used had higher systolic blood pressure values during the first 5 min of anesthesia and fewer episodes of nausea. The risk of hypotension remains substantial.
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Int J Obstet Anesth · Oct 2011
Case ReportsRole of prophylactic uterine artery balloon catheters in the management of women with suspected placenta accreta.
Placenta praevia and accreta are leading causes of major obstetric haemorrhage and peripartum hysterectomy. Detection is largely based on a high index of clinical suspicion, though the diagnostic accuracy of radiological imaging is improving. Interventional radiological techniques can reduce blood loss and the incidence of hysterectomy. ⋯ In our case series in women with suspected placenta accreta, prophylactic use of uterine artery balloons was associated with a low requirement for blood transfusion but with possible increased risk of fetal compromise. Performing the interventional procedure at a different site from the operative room complicated management.
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Int J Obstet Anesth · Oct 2011
Case ReportsAnaesthetic management of a parturient with Laron syndrome.
We report a case of a parturient with Laron syndrome, a rare form of dwarfism which results from an inability to generate insulin-like growth factor 1. In addition to dwarfism these patients may have craniofacial abnormalities, atlantoaxial instability, spinal stenosis and metabolic, musculoskeletal and genitourinary abnormalities. The patient underwent an urgent caesarean section using combined spinal-epidural anaesthesia. Laron syndrome is reviewed and its anaesthetic implications discussed.
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Int J Obstet Anesth · Oct 2011
Case ReportsBlood patches may cause scarring in the epidural space: two case reports.
The use of epidural blood patches has become standard treatment for postdural puncture headache. Two cases suggest that there may occasionally be incomplete resorption of the blood patch, resulting in scarring in the epidural space that can be visualised using postpartum contrast injection and fluoroscopy. ⋯ Epidural insertion was then repeated, resulting in successful anaesthesia in one patient but a total subdural block with delayed apnoea and unconsciousness in the other. Distortion of epidural anatomy by fibrosis was considered to be a possible cause.