International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2010
Comparative StudyRetrospective study of association between choice of vasopressor given during spinal anaesthesia for high-risk caesarean delivery and fetal pH.
Phenylephrine given during spinal anaesthesia for low-risk caesarean section is associated with higher fetal pH than ephedrine. However, there is little evidence on the effects of ephedrine and phenylephrine in complicated pregnancies. The aim of this study was to compare umbilical artery pH with phenylephrine and ephedrine given during spinal anaesthesia where caesarean section was performed because of an increased risk of fetal compromise. ⋯ Umbilical artery pH was similar whether ephedrine or phenylephrine was used to maintain maternal arterial pressure, which contrasts with studies of low-risk caesarean section.
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Int J Obstet Anesth · Jan 2010
Case ReportsParadoxical amniotic fluid embolism presenting before caesarean section in a woman with an atrial septal defect.
We present a case of presumed amniotic fluid embolism in a 33-year-old parturient at 30 weeks of gestation, which occurred just before she was due to receive spinal anaesthesia for urgent caesarean section. While sitting, the woman suddenly lost consciousness, started having convulsions and finally suffered cardiorespiratory collapse. She was resuscitated and a live baby was delivered by emergency caesarean section. ⋯ After extubation she was aphasic and had a right hemiparesis. She made a good recovery and was discharged from hospital 24 days later, at which time she had a slight weakness on her right side. Three months later she had a normal gait with no obvious neurological deficit.
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Int J Obstet Anesth · Jan 2010
Case ReportsAnesthetic management of a patient with cleidocranial dysplasia undergoing various obstetric procedures.
Patients with cleidocranial dysplasia, a rare autosomal dominant genetic syndrome, possess abnormal anatomical features of the head, mouth, neck and spinal column. These features may result in perioperative problems such as difficult airway and complicated regional anesthesia. We report the anesthetic management of a young woman with cleidocranial dysplasia undergoing four caesarean sections, one vaginal delivery and a dilatation and curettage, employing different modes of anesthesia. Anesthetic management in this disorder presents challenges for both general and neuraxial anesthesia.
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Int J Obstet Anesth · Jan 2010
Intrathecal anesthesia for cesarean delivery via a subarachnoid drain in a woman with benign intracranial hypertension.
A 26-year-old primiparous patient with intractable benign intracranial hypertension treated by cerebrospinal fluid drainage through an indwelling spinal catheter was expecting twins. At 30 weeks she presented for emergent cesarean delivery secondary to a non-reassuring fetal condition. In consultation with the neurosurgical team, spinal anesthesia for the cesarean delivery was induced successfully through the spinal catheter. Cesarean delivery proceeded uneventfully with a favorable neonatal outcome.
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Int J Obstet Anesth · Jan 2010
Comparative StudyAnalgesic requirements and postoperative recovery after scheduled compared to unplanned cesarean delivery: a retrospective chart review.
Studies examining the effects of various analgesics and anesthetics on postoperative pain following cesarean delivery conventionally use the scheduled cesarean population. This study compares postoperative analgesic requirements and recovery profiles in women undergoing scheduled cesarean compared to unplanned cesarean delivery following labor. We postulated that unplanned cesarean deliveries may increase postoperative analgesic requirements. ⋯ The results indicate that women experience similar pain and analgesic requirements after scheduled compared to unplanned cesarean delivery. This suggests that the non-scheduled cesarean population may be a suitable pain model to study pain management strategies; and that alterations in pain management are not necessary for the unplanned cesarean delivery population.