International journal of obstetric anesthesia
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Cell salvage is increasingly used in the management of major obstetric haemorrhage. Its financial considerations were evaluated over a 5-year period. ⋯ The routine use of cell salvage was associated with more salvaged blood being returned to patients, which offset the cost of collection sets when compared to the cost of using allogeneic blood. Cell salvage is an appropriate expenditure to reduce the use of allogeneic blood.
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The α(2) adrenergic receptor agonist dexmedetomidine has some unique pharmacologic properties that could benefit pregnant patients (and their fetuses) when they require sedation, analgesia, and/or anesthesia during pregnancy. The purpose of the present study was to delineate maternal and fetal responses to an intravenous infusion of dexmedetomidine. ⋯ Using a clinically-relevant dosing regimen, intravenous infusion of dexmedetomidine produced significant maternal sedation without altering fetal physiologic status. Results from this initial acute assessment support the conduct of further studies to determine if dexmedetomidine has clinical utility for sedation and pain control during pregnancy.
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Int J Obstet Anesth · Oct 2012
Randomized Controlled Trial Comparative StudyA comparison of epidural magnesium and/or morphine with bupivacaine for postoperative analgesia after cesarean section.
Magnesium can potentiate the antinociceptive effect of morphine. This prospective randomized double-blinded study was undertaken to establish the analgesic effect of adding magnesium to epidural morphine during cesarean section. ⋯ Addition of magnesium 500 mg and morphine 1.5mg to epidural 0.1% bupivacaine 10 mL reduced postoperative pain compared with addition of morphine or magnesium alone or no additive.
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Int J Obstet Anesth · Oct 2012
Case ReportsPlacental abruption occurring soon after labor combined spinal-epidural analgesia.
We present a case of placental abruption necessitating emergency cesarean section in an otherwise uncomplicated patient soon after initiation of combined spinal-epidural analgesia in labor. Administration of spinal opioids has the potential to cause fetal bradycardia due to uterine hypertonicity following rapid onset of analgesia. In this case, a previously bloody show before placement of combined spinal-epidural analgesia may have been evidence of a small abruption. We hypothesize that uterine hypertonicity following administration of spinal opioids may have hastened the development of an existing placental abruption.
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Int J Obstet Anesth · Oct 2012
Can the passive leg raise test predict spinal hypotension during cesarean delivery? An observational pilot study.
It was hypothesized that patients who are preload dependent, as demonstrated by a >12% increase in cardiac output in response to a passive leg raise test, would be more likely to exhibit hypotension during spinal anesthesia for cesarean delivery. ⋯ In this pilot study, non-invasive assessment of the hemodynamic response to a volume load was not predictive of hypotension or vasopressor use during cesarean delivery under spinal anesthesia. Fluid responsiveness was related to hemodynamic responses at delivery.