International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2011
Case ReportsThe use of thromboelastography for the peripartum management of a patient with platelet storage pool disorder.
We describe the peripartum management of a 26-year-old primigravida with a platelet storage pool disorder who underwent spontaneous vaginal delivery of twins with epidural analgesia. Postpartum hemorrhage from uterine atony, and cervical and vaginal lacerations were treated successfully with 1-desamino-8D-arginine vasopressin and blood products. The use of thromboelastography in the assessment and management of bleeding risk in the setting of platelet storage pool disorder is described.
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Int J Obstet Anesth · Apr 2011
Case ReportsUrgent cesarean delivery and prolonged ventilatory support in a parturient with Fontan circulation and undiagnosed pseudocholinesterase deficiency.
A parturient with Fontan circulation required general anesthesia for urgent cesarean delivery and subsequent prolonged postoperative ventilation for newly-diagnosed pseudocholinesterase deficiency. Anesthetic management necessitated a thorough understanding of the hemodynamic principles of the Fontan circulation and physiologic adaptations during surgical delivery and recovery in the intensive care unit.
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Int J Obstet Anesth · Apr 2011
Estimation of infant dose and exposure to pethidine and norpethidine via breast milk following patient-controlled epidural pethidine for analgesia post caesarean delivery.
There is no information about the distribution of pethidine into breast milk and/or exposure of the breastfed infant during pethidine patient-controlled epidural analgesia after caesarean delivery. ⋯ The combined absolute infant dose of pethidine and norpethidine received via milk was 1.8% of the neonatal therapeutic dose and the combined relative infant dose was below the 10% recommended safety level. Breastfed infants are at low risk of drug exposure when mothers self-administer epidural pethidine after caesarean delivery.
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Int J Obstet Anesth · Apr 2011
An observational study of factors leading to difficulty in resident anaesthesiologists identifying the epidural space in obstetric patients.
Multiple attempts at needle placement for neuraxial block may cause patient discomfort, a higher incidence of spinal haematomas, postdural puncture headache and nerve trauma. The aim of this study was to evaluate the factors predicting difficult epidural analgesia for inexperienced residents. ⋯ For residents with no prior experience in obstetric anaesthesia, the most reliable factor in predicting difficult epidural cannulation was spinal abnormality.