International journal of obstetric anesthesia
-
Successful pregnancy requires a state of immune homeostasis. Maternal tolerance of the genetically distinct fetoplacental unit is in part mediated by maternal and fetal pro- and anti-inflammatory cytokines; these cytokines have also been implicated in different pregnancy-related pathologic states. ⋯ In part one, we review basic and pregnancy-related elements of the immune system, with an emphasis on the role of cytokines. From this foundation, we offer a perspective of a unique phenomenon witnessed within obstetric anesthesia - maternal temperature elevation associated with labor epidural analgesia.
-
Int J Obstet Anesth · May 2016
ReviewThe 2016 Hughes Lecture: What's new in maternal morbidity and mortality?
Each year, the Board of Directors of the Society for Obstetric Anesthesia and Perinatology selects an individual to review a given year's published obstetric anesthesiology literature. This individual then produces a syllabus of the year's most influential publications, delivers the Ostheimer Lecture at the Society's annual meeting, the Hughes Lecture at the following year's Sol Shnider meeting, and writes corresponding review articles. ⋯ This is followed by a discussion of specific coexisting diseases and specific causes of severe maternal mortality. The review ends with a discussion of worldwide maternal mortality and the 2014 publications that examined the successes and the shortfalls in the work to make childbirth safe for women throughout the entire world.
-
Int J Obstet Anesth · May 2016
Randomized Controlled TrialEffect of preoperative pregabalin on post-caesarean delivery analgesia: a dose-response study.
We hypothesised that preoperative administration of a single-dose of pregabalin would be associated with lower morphine consumption after uncomplicated caesarean delivery. ⋯ In our study, preoperative administration of pregabalin 300mg reduced postoperative morphine consumption and early postoperative pain in parturients undergoing elective caesarean delivery, although maternal side effects were more common.
-
Int J Obstet Anesth · May 2016
Comparative StudyCatheter failure rates and time course with epidural versus combined spinal-epidural analgesia in labor.
The combined spinal-epidural technique for labor analgesia has several advantages over the traditional epidural technique, including faster onset, greater maternal satisfaction, and decreased need for physician boluses. Proponents of the epidural technique criticize the combined spinal-epidural technique, arguing that the epidural catheter remains untested and thus may not be reliable if needed for surgical intervention. We compared failure rates and time of failure between techniques in our tertiary-care academic practice. ⋯ We were able to demonstrate that catheters placed using a combined spinal-epidural technique were less likely to fail during labor and that the time to detection of a failed catheter was significantly longer in the combined spinal-epidural group. Our findings validate the combined spinal-epidural technique as reliable for labor analgesia and tend to refute the theory of the untested catheter.