International journal of obstetric anesthesia
-
Int J Obstet Anesth · Oct 2012
Review Meta AnalysisRisk factors for failed conversion of labor epidural analgesia to cesarean delivery anesthesia: a systematic review and meta-analysis of observational trials.
Multiple labour epidural top-up boluses, caesarean section urgency or care by non-obstetric anaesthetists increase risk of failed epi anaesthesia.
pearl -
Int J Obstet Anesth · Oct 2012
Case ReportsPlacental abruption occurring soon after labor combined spinal-epidural analgesia.
We present a case of placental abruption necessitating emergency cesarean section in an otherwise uncomplicated patient soon after initiation of combined spinal-epidural analgesia in labor. Administration of spinal opioids has the potential to cause fetal bradycardia due to uterine hypertonicity following rapid onset of analgesia. In this case, a previously bloody show before placement of combined spinal-epidural analgesia may have been evidence of a small abruption. We hypothesize that uterine hypertonicity following administration of spinal opioids may have hastened the development of an existing placental abruption.
-
Int J Obstet Anesth · Oct 2012
Pharmacokinetics of intravenous ketorolac following caesarean delivery.
Drug disposition is altered by pregnancy and the peripartum period but data on intravenous ketorolac pharmacokinetics following caesarean delivery have not been previously reported. ⋯ Ketorolac clearance and distribution volume are significantly increased following caesarean delivery. These data provide pharmacokinetic estimates on which to base studies on post caesarean analgesia.
-
Int J Obstet Anesth · Oct 2012
Case ReportsEpidural lipomatosis causing new debilitating back pain in a patient with human immunodeficiency virus on highly active antiretroviral therapy.
Spinal epidural lipomatosis is a rare condition of adipose tissue hypertrophy in the epidural space. Through nerve root and spinal canal compression, it may lead to both sensory and motor compromise. Chronic steroid use, obesity and other metabolic derangements are known causes of spinal epidural lipomatosis. ⋯ Epidural lipomatosis was diagnosed by magnetic resonance imaging. Given her evolving symptoms, neuraxial anesthesia was considered to be contraindicated. We present her management and labor course.
-
Int J Obstet Anesth · Oct 2012
Can the passive leg raise test predict spinal hypotension during cesarean delivery? An observational pilot study.
It was hypothesized that patients who are preload dependent, as demonstrated by a >12% increase in cardiac output in response to a passive leg raise test, would be more likely to exhibit hypotension during spinal anesthesia for cesarean delivery. ⋯ In this pilot study, non-invasive assessment of the hemodynamic response to a volume load was not predictive of hypotension or vasopressor use during cesarean delivery under spinal anesthesia. Fluid responsiveness was related to hemodynamic responses at delivery.