International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2014
Randomized Controlled TrialEvaluation of levobupivacaine passage to breast milk following epidural anesthesia for cesarean delivery.
Following maternal administration, local anesthetics pass into breast milk. In the present study, we aimed to compare the passage of levobupivacaine and bupivacaine into breast milk following epidural anesthesia for cesarean delivery. ⋯ Both levobupivacaine and bupivacaine pass into breast milk following epidural administration. The concentration of both drugs was approximately three times lower in breast milk than in maternal plasma.
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Int J Obstet Anesth · Aug 2014
Anticoagulant prescribing practices and anesthetic interventions among anticoagulated pregnant patients: a retrospective study.
The peripartum management of anticoagulated patients poses important challenges for obstetric anesthesiologists, especially when deciding to perform neuraxial block. However, there is limited evidence evaluating anticoagulant prescribing practices and neuraxial block utilization in this setting. Our objective was to examine peripartum anticoagulant prescribing and anesthetic practices in a cohort of anticoagulated patients receiving subcutaneous enoxaparin, and subcutaneous or intravenous unfractionated heparin. ⋯ In this study, the neuraxial block rate was high among patients receiving enoxaparin and/or subcutaneous unfractionated heparin with patients undergoing relatively long periods off anticoagulation. Careful multidisciplinary planning is recommended for the peripartum management of anticoagulated pregnant patients.
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Int J Obstet Anesth · Aug 2014
Randomized Controlled TrialPrevention versus treatment of intrathecal morphine-induced pruritus with ondansetron.
Intrathecal morphine is used for post-cesarean analgesia, but pruritus is a common side effect. Ondansetron would be an attractive treatment because it prevents nausea, is non-sedative or has no anti-analgesic effect. We undertook a study to assess the efficacy of ondansetron for treatment or prophylaxis of intrathecal morphine-induced pruritus. ⋯ Prophylactic ondansetron did not reduce pruritus when compared with placebo. The use of ondansetron as a treatment did not decrease the severity of pruritus when compared with placebo.
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Int J Obstet Anesth · Aug 2014
ReviewEstablishing an obstetric neuraxial service in low-resource areas.
The proportion of laboring women utilizing neuraxial techniques for labor analgesia has steadily increased over the past decades in North America, the UK and parts of Europe. Anesthesiologists in many other countries may want to introduce an obstetric neuraxial service but may lack the knowledge and experience necessary to ensure its safety. The focus of this article is to address the necessity, benefit and challenges of establishing such a service in a resource-limited environment. ⋯ Patient education and satisfaction are additional key components of a successful service. Even in financially low-resource settings, proper safety measures must be adopted so that the neuraxial procedure itself does not contribute to morbidity and mortality. A viable and safe neuraxial service can be developed using innovative strategies based on local constraints.