International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2022
Letter Randomized Controlled TrialEffect of different crystalloid preload volumes combined with prophylactic norepinephrine infusion on inferior vena cava collapsibility index and post-spinal anesthesia hypotension during cesarean section: a randomized controlled trial.
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Int J Obstet Anesth · Nov 2022
Respiratory depression after administration of single-dose neuraxial morphine for post-cesarean delivery analgesia: a retrospective cohort study.
Neuraxial administration of long-acting opioid is the "gold standard" for the management of postoperative pain following cesarean delivery. Respiratory depression, however, remains a concerning complication. ⋯ Clinically significant respiratory depression is rare among patients receiving neuraxial morphine for post-cesarean delivery analgesia.
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Int J Obstet Anesth · Nov 2022
Investigating the use of non-loss of resistance syringes for epidural insertion: experience on a mannequin.
The Obstetric Anaesthetists' Association has released a statement outlining the disruption to supply of the Portex® Loss of Resistance Syringe (Smiths Medical, UK) which is commonly used for epidural insertion within our Trust. We sought to investigate the use of standard available syringes for epidural insertion and whether tactile feedback when getting loss of resistance was similar. ⋯ Using an epidural training mannequin, this study suggests that it is still possible to elicit clear loss of resistance using alternative syringes. Of the three alternative syringes commonly available in our organisation, the BD Emerald 10 mL syringe was the most popular.
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This case report addresses the management of a pregnant woman in the peripartum period with a VIPoma. This rare and highly malignant neuroendocrine tumour secretes vasoactive intestinal peptide (VIP), a substance that may cause potentially life-threatening disruption to physiology. ⋯ The patient delivered a healthy boy with the aid of forceps in theatre following an epidural top-up. Key features of management were a multidisciplinary approach, avoidance of triggers for VIP secretion, strict management of electrolytes and avoidance of severe changes in sympathetic tone during labour with epidural analgesia.