International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2017
Neuraxial analgesia in a pregnant woman with Fowler's syndrome and sacral neuromodulation.
We report the anesthetic management of a 16-year-old woman with Fowler's syndrome who became pregnant three years after sacral neuromodulation was initiated for treatment of the condition. Multidisciplinary consensus was to switch off the neurostimulator during pregnancy, and attempt vaginal delivery with a neuraxial block. ⋯ Sacral neuromodulation was restarted uneventfully in the early puerperium and the Fowler's syndrome remains well controlled. The baby continues to develop normally three years after delivery.
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Int J Obstet Anesth · May 2017
Observational StudyAbdominal girth, vertebral column length and spread of intrathecal hyperbaric bupivacaine in the term parturient.
We aimed to test whether abdominal girth and vertebral column length were predictors of spinal hyperbaric bupivacaine spread in term parturients. ⋯ Parturient abdominal girth and vertebral column length have significant predictive value in determining the cephalad spread of spinal anaesthesia with hyperbaric bupivacaine in term parturients.
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Int J Obstet Anesth · May 2017
Anaesthesia for abnormally invasive placenta: a single-institution case series.
Abnormally invasive placenta describes a spectrum of disorders resulting in pathological placental implantation. It is associated with the potential for severe maternal haemorrhage and poor fetal outcome. Increasing numbers of women are at risk owing to the rising incidence of uterine surgery and increasing maternal age. We report data over a five-year period describing anaesthetic management of cases of abnormally invasive placenta in a UK tertiary-referral maternity unit and assess how management has developed. ⋯ Our data illustrate the burden on healthcare resources associated with management of abnormally invasive placenta, underlining the continued need for centralised services for treatment of these complex cases. An integrated multidisciplinary approach to case planning, case management and service provision is key to a successful outcome in these cases.
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Int J Obstet Anesth · May 2017
Novel 3D ultrasound system for midline single-operator epidurals: a feasibility study on a porcine model.
We developed a real-time 3D ultrasound thick slice rendering technique and innovative Epiguide needle-guide as an adjunct to single-operator midline epidural needle insertions. Study goals were to determine feasibility of the technique in a porcine model and compare the visibility of standard and echogenic needles. ⋯ It is feasible to perform 3D ultrasound-guided real-time single-operator midline epidural insertions, in a porcine model. Echogenic needles were found to consistently improve needle visibility; and improved needle visibility tended to increase successful entry into epidural space.