International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2011
Case ReportsProphylactic endovascular placement of internal iliac occlusion balloon catheters in parturients with placenta accreta: a retrospective case series.
Endovascular occlusion balloon catheters can be placed preoperatively in internal iliac vessels of patients perceived to be at risk of major obstetric haemorrhage during caesarean section. Their safety and efficacy remains undefined, and we report our experience of 14 patients over four years. ⋯ Internal iliac balloon catheters can be inserted electively or in an emergency in patients at risk of major obstetric haemorrhage. Although useful in some, they are not universally effective; patients are still at risk of significant blood loss and at high risk of requiring a hysterectomy. In our experience, catheters can be placed electively or in an emergency but have been associated with adverse outcomes. These lessons have been important learning points in perioperative management.
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Int J Obstet Anesth · Jan 2011
Randomized Controlled Trial Comparative StudyLow-dose ketamine with multimodal postcesarean delivery analgesia: a randomized controlled trial.
Ketamine at subanesthetic doses has analgesic properties that have been shown to reduce postoperative pain and morphine consumption. We hypothesized that intravenous ketamine 10mg administered during spinal anesthesia for cesarean delivery, in addition to intrathecal morphine and intravenous ketorolac, would decrease the incidence of breakthrough pain and need for supplemental postoperative analgesia. ⋯ We found no additional postoperative analgesic benefit of low-dose ketamine during cesarean delivery in patients who received intrathecal morphine and intravenous ketorolac. Subjects who received ketamine reported lower pain scores 2weeks postpartum.
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Several previous publications demonstrate the significant haemodynamic effects of oxytocin in healthy pregnant women, but there is only one publication of the oxytocin effects in women with severe preeclampsia. We investigated the haemodynamic effects of oxytocin in women with severe preeclampsia using invasive haemodynamic monitoring. ⋯ The haemodynamic effects of oxytocin in women with severe preeclampsia may be less predictable compared to findings in healthy pregnant women, suggesting that oxytocin should be given with caution in women with severe preeclampsia.