International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2012
Case ReportsMultidisciplinary management of an obstetric patient with glycogen storage disease type 3.
A 22-year-old primiparous woman with known glycogen storage disease type 3a presented to our hospital during her 12th week of pregnancy. Glycogen storage disease type 3 is a rare inherited disorder resulting from a deficiency of the glycogen debranching enzyme, causing the accumulation of abnormal short-chain glycogen in liver, blood cells, myocardium and striated muscle. Symptoms improve after puberty but the increased metabolism of pregnancy predisposes to hypoglycaemia, ketosis and lactic acidosis. ⋯ Intravenous dextrose infusion and regular blood glucose monitoring were used during the perinatal period to prevent hypoglycaemia. An arterial line was inserted in the operating room for frequent blood sampling and to avoid muscle cramps which could be induced by the intermittent inflation of the automated blood pressure cuff. Obstetric, anaesthetic and neonatal outcomes were uneventful.
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Int J Obstet Anesth · Jan 2012
Randomized Controlled TrialIntrathecal fentanyl added to bupivacaine and morphine for cesarean delivery may induce a subtle acute opioid tolerance.
Previous studies have demonstrated that the addition of intrathecal fentanyl to a spinal anesthetic for cesarean delivery improves intraoperative analgesia. However, intrathecal fentanyl may induce acute tolerance to opioids. The objective of this study was to investigate whether the addition of intrathecal fentanyl to spinal anesthesia with intrathecal morphine increases postoperative analgesic requirements and pain scores. ⋯ The study results suggest that intrathecal fentanyl may induce acute tolerance to intrathecal morphine. However, because there was no difference in postoperative analgesia requirement and the difference in pain scores was small, the clinical significance of this finding is uncertain.
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Int J Obstet Anesth · Jan 2012
Randomized Controlled TrialOnset of labor epidural analgesia with ropivacaine and a varying dose of fentanyl: a randomized controlled trial.
This study was conducted to investigate the onset of labor epidural analgesia using 0.17% ropivacaine with a varying dose of fentanyl. We hypothesized that the onset of analgesia would be shortened in proportion to an increase in fentanyl dose. ⋯ The addition of increasing doses of fentanyl to 0.17% ropivacaine contributed to shortened onset as well as prolonged duration of labor epidural analgesia and improved patient satisfaction.
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Int J Obstet Anesth · Jan 2012
ReviewWhat's new in obstetric anesthesia: the 2011 Gerard W. Ostheimer lecture.
The Gerard W. Ostheimer lecture is delivered at the Society for Obstetric Anesthesia and Perinatology Annual Meeting. The lecture provides a comprehensive review of the previous year's literature in obstetric anesthesia, obstetrics, perinatology, and health services research relevant for obstetric anesthesiologists. This article covers several of the major themes that emerged from the 2010 literature.