International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2019
Case ReportsSyncope after administration of epidural analgesia in an obstetric patient with a vagus nerve stimulator.
Vagus nerve stimulation (VNS) is an adjunctive therapy for medically refractory epilepsy and depression. Vagus nerve stimulation is generally well-tolerated, but cardiac arrhythmias or asystole are rare complications that have been reported. ⋯ These resolved after deactivating the device. This is the first report of a suspected arrhythmia during VNS in the setting of epidural analgesia.
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Int J Obstet Anesth · May 2019
Accidental dural puncture during labor analgesia and obstetric outcomes in nulliparous women.
The effect of accidental dural puncture during labor epidural analgesia on obstetric outcomes remains unexplored. In this retrospective cohort study, we tested the hypothesis that accidental dural puncture is associated with prolonged second stage of labor. ⋯ Accidental dural puncture during labor analgesia was associated with prolonged second stage of labor in nulliparous parturients. Prospective studies are needed to assess the relationship between the quality of neuraxial block after accidental dural puncture and obstetric outcomes.
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Int J Obstet Anesth · May 2019
Observational StudyBaseline parameters for rotational thromboelastometry (ROTEM®) in healthy women undergoing elective caesarean delivery: a prospective observational study in Australia.
Formal reference ranges for rotational thromboelastometry (ROTEM®) in pregnancy have not been obtained in the recommended minimum sample size of 120. This prospective observational study aimed to establish baseline parameters in an Australian population of women undergoing elective caesarean delivery. The secondary aim was to compare these reference ranges with those from prior studies and the manufacturer. ⋯ ROTEM® reference ranges for women with uncomplicated term pregnancies were reported as per the International Federation of Clinical Chemistry. The FIBTEM MCF and FIBTEM/EXTEM/INTEM amplitudes were higher in comparison to the manufacturer's reference ranges for the non-obstetric population. The EXTEM CT was shorter than the non-obstetric reference ranges. These ranges show an increase in coagulability during normal pregnancy compared to the non-pregnant reference ranges.