International journal of obstetric anesthesia
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It is clear from animal studies that commonly used anesthetic agents affect early brain development both histologically and functionally. With human epidemiologic evidence suggesting an association between anesthesia and surgery early in life and late-onset learning disabilities, investigators have focused their attention on the subtle long-term effects of anesthesia exposure. Most obstetric anesthesia studies, however, have focused on either the teratogenic effects of anesthetic agents in the first trimester or on the neonatal status immediately after delivery. ⋯ Of concern though, is that these events are easily perturbed by environmental and pharmacological influences. New research studies have raised significant questions about the fetal impact of maternal anesthesia for non-obstetric and fetal surgery. This review summarizes the major findings in the field of developmental neurotoxicity of anesthetic agents, discusses the susceptibility of the fetal brain to anesthetic effects in a trimester-specific style, and outlines the pitfalls in extrapolating animal research to humans.
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Int J Obstet Anesth · Apr 2012
Randomized Controlled TrialA sequential compression mechanical pump to prevent hypotension during elective cesarean section under spinal anesthesia.
Spinal anesthesia is a standard technique for cesarean section but can cause hypotension which may be related to venous pooling secondary to progesterone-induced decreases in vascular tone. This study investigated the use of a sequential compression mechanical pump with thigh-high sleeves with compression cycles timed to venous refilling. We hypothesized that this would recruit pooled venous blood from the lower limbs, maintain the central blood volume and thus decrease the incidence of hypotension. ⋯ The use of a sequential compression mechanical pump that detects venous refilling and cycles accordingly, reduced the incidence and severity of hypotension after spinal anesthesia for cesarean section.
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Int J Obstet Anesth · Apr 2012
Case ReportsAnesthetic management of a spontaneous spinal-epidural hematoma during pregnancy.
Spontaneous spinal-epidural hematoma is uncommon and rare during pregnancy. We were presented with a 31-year-old patient who developed back pain with lower extremity paralysis at 36 weeks of gestation. ⋯ Postoperatively, dopamine was infused to maintain the blood pressure within the high-normal range to optimize spinal cord perfusion. Successful anesthetic and postoperative management is described together with a review of the literature.
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Int J Obstet Anesth · Apr 2012
The Analgesia Nociception Index: a pilot study to evaluation of a new pain parameter during labor.
Objective pain assessment that is not subject to influences from either cultural or comprehension issues is desirable. Analysis of heart rate variability has been proposed as a potential method. This pilot study aimed to assess the performance of the PhysioDoloris™ analgesia monitor which calculates an Analgesia Nociception Index derived from heart rate variability. It was compared with visual analogical pain scores. ⋯ The Analgesia Nociception Index has an inverse linear relationship with visual analogical pain scores. Further studies are necessary to confirm the results of this pilot study and to look at the influence of epidural analgesia on the Analgesia Nociception Index.
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Int J Obstet Anesth · Apr 2012
Case ReportsAcute intrathecal haematoma following neuraxial anaesthesia: diagnostic delay after apparently normal radiological imaging.
We describe a case of intrathecal haematoma following combined spinal-epidural anaesthesia for caesarean section. The parturient was previously well with no risk factors for haematoma development. ⋯ Incorrect interpretation of clinical findings and magnetic resonance imaging contributed to the delay in definitive treatment. We discuss the difficulties in diagnosis, image interpretation and the need for a specialist opinion when abnormal neurological symptoms persist despite apparently normal imaging.