International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2011
Randomized Controlled Trial Comparative StudySerum oxytocin concentrations in elective caesarean delivery: a randomized comparison of three infusion regimens.
The aim of this study was to determine serum oxytocin concentrations following different regimens of prophylactic oxytocin administration in women undergoing elective caesarean delivery. ⋯ Serum oxytocin measurements made using enzyme immunoassay in healthy pregnant women undergoing elective caesarean delivery showed that administration of 80 IU oxytocin over 30 min resulted in higher serum oxytocin levels after 5 and 30 min than the two other regimens. The concentrations did not differ between groups at 60 min.
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Int J Obstet Anesth · Jul 2011
Randomized Controlled Trial Comparative StudyComparison of relative potency of intrathecal bupivacaine for motor block in pregnant versus non-pregnant women.
Pregnancy is associated with facilitated spread of spinal and epidural anesthesia. There are limited data available for relative potency of motor block of neuraxial local anesthetics in non-pregnant versus pregnant women. The purpose of this study was to investigate the median effective dose (ED(50)) of intrathecal isobaric bupivacaine for motor block in non-pregnant and pregnant women and to estimate the respective potency ratio. ⋯ Intrathecal bupivacaine was 1.14 times more potent for motor block in pregnant versus non-pregnant women. Our current data confirm the difference in local anesthetic requirement between non-pregnant and pregnant patients.
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Int J Obstet Anesth · Jul 2011
Case ReportsAcute starvation in pregnancy: a cause of severe metabolic acidosis.
We report a case of starvation-induced metabolic ketoacidosis in a previously healthy 29-year-old, nulliparous woman at 32 weeks of gestation. She was admitted to hospital with mild preeclampsia associated with persistent nausea and vomiting that progressed to severe preeclampsia requiring urgent control of hypertension before caesarean delivery. Prolonged and severe vomiting limited oral caloric intake and led to starvation ketoacidosis, characterised by ketonuria and a raised anion gap metabolic acidosis that required intensive care support. ⋯ Fluid restriction used as part of our preeclampsia treatment regimen delayed the therapeutic administration of sufficient dextrose, which rapidly corrected her metabolic derangement when commenced after delivery. Electrolyte supplementation was given to prevent re-feeding syndrome. Both mother and baby were discharged without sequelae.
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Int J Obstet Anesth · Jul 2011
Case ReportsNon-invasive measurement of hemoglobin during cesarean hysterectomy: a case series.
Obstetric patients diagnosed with abnormal placentation (placenta accreta, increta or percreta) are at increased risk of major postpartum hemorrhage and cesarean hysterectomy. Obstetric anesthesiologists are primarily involved in intraoperative transfusion management in these cases. Hemoglobin assessment is invaluable for assisting transfusion decision-making during the acute period of obstetric hemorrhage. ⋯ A new non-invasive hemoglobin monitor has been introduced recently, which provides real-time measurement of hemoglobin values (SpHb) using multi-wavelength pulse co-oximetry. We present a review of five patients with suspected abnormal placentation who received SpHb monitoring during cesarean hysterectomy at our institution. We discuss the potential clinical utility of non-invasive hemoglobin monitoring for pregnant patients at high risk of obstetric hemorrhage, and the potential role of SpHb in guiding transfusion therapy.
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Int J Obstet Anesth · Jul 2011
A retrospective survey of adverse maternal and neonatal outcomes for parturients with congenital heart disease.
Parturients with congenital heart disease are at increased risk of maternal cardiac and neonatal complications. There is a paucity of literature regarding the relationship of complications with the type of anesthesia or mode of delivery. ⋯ Despite a low overall incidence of maternal and neonatal mortality, pregnancy in women with congenital heart disease was associated with significant maternal cardiac and neonatal complications. Elective cesarean delivery with neuraxial anesthesia was a common approach for high-risk parturients with congenital heart disease; however, the benefit of this mode of delivery and anesthetic technique could not be ascertained.