International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2014
Case ReportsConcealed paracetamol overdose treated as HELLP syndrome in the presence of postpartum liver dysfunction.
Paracetamol is the most frequently used analgesic during pregnancy and the most common drug involved in suicidal overdose in the UK. Manifestation of toxicity classically occurs over four phases with clinical and laboratory features resembling HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome. We report a case that was erroneously managed as HELLP syndrome before a paracetamol overdose was diagnosed. This case highlights current practice in managing paracetamol overdose and focuses on the importance of addressing mental health issues to mitigate the risk of self-harm in pregnancy.
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Int J Obstet Anesth · May 2014
The incidence and management of inability to advance Arrow FlexTip Plus® epidural catheters in obstetric patients.
Difficulty advancing epidural catheters is troublesome to obstetric anesthesiologists. Flexible epidural catheters have been shown to reduce paresthesiae and intravascular catheter placement in parturients, but the cause of inability to advance these catheters past the epidural needle tip remains undefined. Specifically, its incidence and effective management strategies have not been described. ⋯ Inability to advance Arrow FlexTip Plus® epidural catheters was relatively common (4.5%) and occurred despite confidence in obtaining loss of resistance. Injecting saline may be corrective and appears to have little disadvantage. However, removing the needle and performing a new placement was the most successful corrective maneuver.
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Int J Obstet Anesth · May 2014
Letter Case ReportsMultiple electrode aggregometry in severe obstetric haemorrhage.
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Int J Obstet Anesth · May 2014
Randomized Controlled Trial Comparative StudyA randomized, observer-blind comparison between the Neurotip mounted Neuropen and a disposable plastic neurological wheel for assessing the level of spinal blockade at cesarean section.
Various methods are used to assess the height of sensory block to touch under spinal anesthesia for cesarean section. We tested a novel, inexpensive, miniature, user-dependent plastic neurological wheel against the user-independent Neurotip mounted Neuropen. ⋯ The compact plastic neurological wheel is as clinically reliable as the Neurotip mounted Neuropen.