International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2018
Case ReportsCombined spinal-epidural anesthesia with non-invasive ventilation during cesarean delivery of a woman with a recent diagnosis of amyotrophic lateral sclerosis.
Amyotrophic lateral sclerosis is the most common neurodegenerative upper and lower motor neuron disease in adults but is not common in women of child-bearing age. We present a case of a pregnant woman who was diagnosed with amyotrophic lateral sclerosis and developed respiratory distress at 32 weeks-of-gestation. She underwent a cesarean delivery under combined spinal-epidural anesthesia with non-invasive ventilation. This resulted in a successful outcome for both the mother and the baby.
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Int J Obstet Anesth · Nov 2018
Observational StudyClearsight™ use for haemodynamic monitoring during the third trimester of pregnancy - a validation study.
We assessed the validity of Clearsight™ as a non-invasive cardiac output and stroke volume monitoring device, comparing it with transthoracic echocardiography measurements during the third trimester of pregnancy. ⋯ The agreement between Clearsight™ and the echocardiography measurements of cardiac output and stroke volume were not within an acceptable range in the third trimester of pregnancy.
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Int J Obstet Anesth · Nov 2018
Case ReportsNew onset acute pulmonary edema after methylergonovine given during cesarean delivery of a patient with undiagnosed Raynaud's disease.
Raynaud's disease is a medical condition in which arterial spasm causes episodes of reduced blood flow, in the setting of certain triggers such as cold weather. Patients with this condition are at risk of adverse reactions if they receive medications with vasoactive properties. ⋯ However, pulmonary events have rarely been reported. We report our anesthetic management of a 36-year-old patient, with undiagnosed Raynaud's disease and undergoing cesarean delivery, who experienced new onset acute pulmonary edema after methylergonovine administration to manage postpartum hemorrhage.
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Int J Obstet Anesth · Nov 2018
Risk factors for post-dural puncture headache following injury of the dural membrane: a root-cause analysis and nested case-control study.
Post-dural puncture headache following trauma to the dural membrane during neuraxial anaesthesia occurs in 0.13-6.5% of pregnant patients. Identifying factors beyond individual performance that contribute to this adverse event is crucial to developing improvement strategies. ⋯ Post-dural puncture headache in this setting is not the result of the individual anaesthetist's characteristics alone. Additional factors including team composition, the presence of obstetrical perinatal pathology, and associated patient's conditions, are also associated with this event. Improvement strategies should consider all these factors.
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Int J Obstet Anesth · Nov 2018
A survey of practice of rapid sequence induction for caesarean section in England.
In view of newer techniques of preoxygenation and laryngoscopy and recent obstetric guidelines concerning the management of difficult intubation, we aimed to evaluate the current practice of rapid sequence induction for caesarean section in England. ⋯ Our survey demonstrated the significant variation in the practice of rapid sequence induction for caesarean section in obstetrics in the United Kingdom.