International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2018
Case ReportsAnaesthesia for Caesarean section in a patient with Parkinson's disease.
Parkinson's disease is prevalent worldwide but mainly affects the elderly and is rarely seen in women of child-bearing age. The clinical signs and symptoms, the physiological changes of pregnancy, and drug interactions, pose unique challenges for the anaesthetic management of patients with Parkinson's disease who present for delivery. A 36-year-old primigravid woman at 36 weeks' gestation, with Parkinson's disease, presented for pre-anaesthesia assessment prior to elective caesarean section. ⋯ Spinal anaesthesia for elective Caesarean section was performed in the sitting position, using 0.5% hyperbaric bupivacaine, morphine 150 µg and fentanyl 25 µg. The anaesthesia and Caesarean section were uneventful. She was discharged home with a healthy baby on the fourth postoperative day.
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Int J Obstet Anesth · May 2018
Comparative StudyComparison of rocuronium-induced neuromuscular blockade in second trimester pregnant women and non-pregnant women.
This study set out to compare the onset and duration of rocuronium-induced neuromuscular blockade in second trimester pregnant women and non-pregnant women receiving general anesthesia. ⋯ Our data showed that the rocuronium-induced neuromuscular blockade did not significantly differ in onset but lasted significantly longer in second trimester pregnant women compared with non-pregnant women.
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Int J Obstet Anesth · May 2018
Risk-stratification, resource availability, and choice of surgical location for the management of parturients with abnormal placentation: a survey of United States-based obstetric anesthesiologists.
Parturients with abnormally adherent placentas present anesthetic challenges that include risk-stratification, management planning and resource utilization. The labor and delivery unit may be remote from the main operating room services. ⋯ Obstetric anesthesia leaders identified patients at lower clinical risk and those less likely to require greater resources. Additional resources were available in institutions where all abnormal placentation cases were managed on the labor and delivery unit. Practitioners should consider risk-stratification and resource availability when planning high-risk cases.
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Int J Obstet Anesth · May 2018
Case ReportsDexmedetomidine, high-flow nasal oxygen and sugammadex-reversal of rocuronium: overcoming anaesthetic challenges in a parturient with congenital muscular dystrophy presenting for caesarean section.
Congenital muscular dystrophies are characterised by progressive skeletal muscle weakness from birth or early infancy. Maternal respiratory compromise, joint contractures and presence of spinal instrumentation or fusion are some of the anaesthetic challenges that may be encountered in the obstetric setting. ⋯ Multidisciplinary involvement is paramount to optimise peripartum care and outcomes. In this case report, we present the use of dexmedetomidine, humidified high-flow nasal oxygen, rocuronium and sugammadex in the anaesthetic management of a wheelchair-bound, non-invasive bilevel positive airway pressure ventilation-dependent parturient with congenital muscular dystrophy, who was presenting for caesarean section.
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Int J Obstet Anesth · May 2018
Impact of epidural analgesia on cesarean and operative vaginal delivery rates classified by the Ten Groups Classification System.
The Ten Group Classification System (TGCS) allows critical analysis according to the obstetric characteristics of women in labor: singleton or multiple pregnancy, nulliparous, multiparous, or multiparous with a previous cesarean delivery, cephalic, breech presentation or other malpresentation, spontaneous or induced labor, and term or preterm births. Labor outcomes associated with epidural analgesia may be different among the different labor classification groups. The aim of this study was to explore associations between epidural analgesia and cesarean delivery, and epidural analgesia and assisted vaginal delivery, in women classified using the TGCS. ⋯ Epidural analgesia is associated with different effects on cesarean delivery and assisted vaginal delivery rates in different TGCS groups.