International journal of obstetric anesthesia
-
Int J Obstet Anesth · Oct 2011
ReviewNeuraxial blockade for external cephalic version: a systematic review.
The desire to decrease the number of cesarean deliveries has renewed interest in external cephalic version. The rationale for using neuraxial blockade to facilitate external cephalic version is to provide abdominal muscular relaxation and reduce patient discomfort during the procedure, so permitting successful repositioning of the fetus to a cephalic presentation. This review systematically examined the current evidence to determine the safety and efficacy of neuraxial anesthesia or analgesia when used for external cephalic version. ⋯ Neuraxial blockade improved the likelihood of success during external cephalic version, although the dosing regimen that provides optimal conditions for successful version is unclear. Anesthetic rather than analgesic doses of local anesthetics may improve success. The findings suggest that neuraxial blockade does not compromise maternal or fetal safety during external cephalic version.
-
Despite widespread enthusiasm for using lumbar ultrasound in obstetrics, there are some who believe it is expensive and time-consuming, with undetermined risks and uncertain benefits. For decades, anesthesiologists have striven to perfect the identification and cannulation of the epidural space using skills learned during training and early clinical practice. These skills include knowledge of the relevant anatomy and detection of subtle tactile clues that aid successful placement of an epidural catheter. ⋯ If rapid health cost growth persists, one out of every four dollars in the US national economy will be tied up in the health system by 2025. Do obstetric anesthesiologists want to add to these costs by using unnecessary and expensive equipment? Although many feel that diagnostic ultrasound in obstetrics is safe, some argue that we have yet to perform an appropriate risk analysis for lumbar ultrasound during pregnancy. The issue of ultrasound bio-safety needs to be considered before we all jump on the ultrasound bandwagon.
-
Int J Obstet Anesth · Oct 2011
ReviewMinimally- and non-invasive assessment of maternal cardiac output: go with the flow!
The measurement of cardiac output may be crucial in the management of the parturient with haemodynamic instability due to critical illness or cardiac disease. Invasive haemodynamic monitoring may not be desirable due to the potential risk of complications and issues with patient compliance. Minimally- and non-invasive techniques of cardiac output measurement include those based on ultrasonic technology and pulse contour waveform analysis. This review article provides a synopsis of the literature examining currently available minimally- and non-invasive techniques for maternal cardiac output monitoring and looks at their advantages and disadvantages with respect to the parturient.