International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2020
Case ReportsInhalational induction of general anaesthesia for elective caesarean: ethical acceptability in treatment-resistant needle-phobia?
We describe the anaesthetic management of a parturient who, due to a severe needle phobia, requested an inhalational induction of general anaesthesia for an elective caesarean section. If general anaesthesia is indicated, conventional practice in the UK is to perform a rapid sequence induction via an intravenous route of drug administration to allow rapid intubation of the trachea. ⋯ Despite a thorough consent process highlighting these significant risks, the patient insisted on an inhalational induction of anaesthesia. We present the case and discuss the ethical dilemma (relating to patient care) in situations in which decisions made by patients deviate from medical recommendations.
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Int J Obstet Anesth · Aug 2020
Evaluation of the impact of enhanced recovery after surgery protocol implementation on maternal outcomes following elective cesarean delivery.
Despite significant improvements in outcomes following non-obstetric surgery with implementation of enhanced recovery after surgery (ERAS) protocols, development of these protocols for cesarean delivery is lacking. We evaluated implementation of an ERAS protocol for patients undergoing elective cesarean delivery, specifically the effect on opioid consumption, pain scores and length of stay as well as complications and re-admissions. ⋯ Implementation of ERAS protocols for elective cesarean delivery is associated with significant improvements in analgesic and recovery outcomes. These improvements in quality of care suggest ERAS protocols should be considered for elective cesarean delivery.
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Int J Obstet Anesth · Aug 2020
ReviewExtracorporeal membrane oxygenation in pregnancy and the postpartum period: a systematic review of case reports.
The use of extracorporeal membrane oxygenation (ECMO) as salvage therapy for patients with severe cardiopulmonary failure has increased significantly in the past decade. However, the use of ECMO in pregnant and peripartum patients has received scant attention. We performed a systematic review of case reports in the literature, documenting indications and outcomes of ECMO in pregnancy and postpartum patients. ⋯ Hemorrhage was the most common complication of ECMO reported (31.9%). Of 96 documented neonatal outcomes, 80 neonates (83.3%) survived while 88 of 97 (90.7%) mothers survived. Extracorporeal membrane oxygenation appears to be a viable life support modality in pregnant and postpartum women with severe cardiopulmonary failure, but publication bias in our study cohort should be considered.
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Int J Obstet Anesth · Aug 2020
Review Case ReportsPeri-operative management of percutaneous fetoscopic spina-bifida repair: a descriptive review of five cases from the United Kingdom, with focus on anaesthetic implications.
We present a case-based review of the first five percutaneous fetoscopic in-utero spina bifida repair procedures undertaken in the UK. Our focus is on implications of anaesthesia and analgesia for the mother and fetus, provision of uterine relaxation and fetal immobilisation while providing conditions conducive to surgical access. Minimising risks for fetal acidosis, placental and fetal hypoperfusion, maternal and fetal sepsis and maternal fluid overload were the foremost priorities. We discuss optimisation strategies undertaken to ensure fetal and maternal well-being under anaesthesia, shortcomings in the current approach, and possible directions for improvement.