International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2017
Lessons learned from a single institution's retrospective analysis of emergent cesarean delivery following external cephalic version with and without neuraxial anesthesia.
To evaluate the risk of emergent cesarean delivery with the use of neuraxial anesthesia for external cephalic version in a single practice. ⋯ In this single hospital's practice, patients who may be at higher risk of complications and have a lesser likelihood of success were provided NA for ECV. As a result, the use of neuraxial anesthesia for external cephalic version was associated with a higher rate of emergent cesarean delivery. Obstetric and anesthetic practices should evaluate their patient selection and procedure protocol for external cephalic version under neuraxial anesthesia.
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Int J Obstet Anesth · May 2017
Case ReportsCaesarean delivery in a pregnant woman with epidermolysis bullosa: anaesthetic challenges.
Epidermolysis bullosa is a heterogeneous group of hereditary diseases characterised by extreme fragility of skin and mucosa, with blister and lesion formation spontaneously or in response to trauma. Anaesthetic management of these patients is challenging with respect to positioning, monitoring, use of medical devices and airway management. These challenges are increased when managing labour. We report an elective caesarean delivery in a nulliparous woman with autosomal recessive dystrophic epidermolysis bullosa, managed successfully with spinal anaesthesia.
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Int J Obstet Anesth · May 2017
Case ReportsNeuraxial anesthesia in a patient with anti-N-methyl-D-aspartate receptor encephalitis in pregnancy: management for cesarean delivery and oophorectomy.
We describe the neuraxial anesthetic management of a 28-year-old primigravid patient with severe, treatment-refractory anti-N-methyl-D-aspartate receptor encephalitis undergoing cesarean delivery. The presence of an ovarian teratoma was suspected although not confirmed by imaging. ⋯ A combined spinal-epidural technique was used. Delivery was uneventful, and a right oophorectomy was performed for a visible lesion that was later confirmed to be a mature cystic teratoma.
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Int J Obstet Anesth · May 2017
Neuraxial opioids for post-cesarean delivery analgesia: can hydromorphone replace morphine? A retrospective study.
Cesarean delivery is the most common surgical procedure performed in the USA. We evaluated the postoperative analgesic properties of neuraxial hydromorphone compared to neuraxial morphine for post-cesarean delivery analgesia. ⋯ Hydromorphone is a reasonable alternative to morphine for post-cesarean delivery analgesia. With the dosing used in our study, analgesia from morphine lasted longer than hydromorphone via intrathecal and epidural routes; however, neuraxial hydromorphone remains a reasonable option for long-acting analgesia post cesarean delivery.