International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2019
Case ReportsMultimodal general anesthesia approach for Ex Utero Intrapartum Therapy (EXIT) procedures: two case reports.
High-dose volatile anesthesia is the most common method of achieving uterine relaxation for Ex Utero Intrapartum Therapy (EXIT) procedures. Other methods employ nitroglycerin for additional uterine relaxation with or without remifentanil for additional fetal analgesia. We report a combination approach including one minimum alveolar concentration of volatile anesthetic plus nitroglycerin and remifentanil infusions, to provide timely uterine relaxation under general anesthesia for both mother and fetus, during two EXIT procedures.
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Int J Obstet Anesth · May 2019
Observational StudyIncidence of respiratory depression after epidural administration of morphine for cesarean delivery: findings using a continuous respiratory rate monitoring system.
Epidural morphine is widely used for postoperative analgesia after cesarean delivery. However, respiratory depression can occur after neuraxial administration of morphine. Previous reports describing respiratory depression in obstetric patients have relied on intermittent visual counting of the respiratory rate. In this study, we estimated the incidence of respiratory depression in patients who had received epidural morphine after cesarean delivery, using a continuous respiratory rate monitoring system with a finger sensor. ⋯ Approximately half the women experienced mild respiratory depression, but only one developed moderate respiratory depression. Continuous respiratory rate monitoring until ambulation may assist in early identification of respiratory depression after neuraxial administration of morphine.
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Int J Obstet Anesth · May 2019
Case ReportsRotational thromboelastometry (ROTEM®)-guided diagnosis and management of amniotic fluid embolism.
Point-of-care haemostasis testing may be helpful in rapidly diagnosing amniotic fluid embolism.
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Int J Obstet Anesth · May 2019
Observational StudyDetermination of ChloraPrep® drying time before neuraxial anesthesia in elective cesarean delivery. A prospective observational study.
ChloraPrep® is a skin antiseptic commonly used before neuraxial anesthesia. It is believed that skin must be allowed to dry to prevent nerve damage by seeding ChloraPrep® solution into the neuraxis. We aimed to determine ChloraPrep® drying time in pregnant women before initiation of neuraxial anesthesia. ⋯ Our results suggest that ChloraPrep® drying time may be longer than the current manufacturer-recommended guideline of three minutes. The amount of ChloraPrep® used, application methods, patient characteristics, and environmental factors could influence the drying time.