International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2009
Review Meta AnalysisPeripartum anesthetic management of patients with aortic valve stenosis: a retrospective study and literature review.
Anesthetic management of parturients with aortic stenosis is controversial. Early studies suggest maternal mortality was related to cardiac condition and anesthetic care. In this report, management of parturients with moderate or severe aortic stenosis in two institutions is compared, and published cases are reviewed. ⋯ Carefully titrated regional analgesia is usually well tolerated in patients undergoing vaginal or cesarean delivery even in the presence of severe aortic stenosis. Standard monitoring is usually adequate for vaginal delivery, but invasive monitoring may facilitate management in some patients. An arterial line allows close monitoring of systemic blood pressure. Facilities for close 24-48-h post-partum observation should be available. A multidisciplinary approach is needed.
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Int J Obstet Anesth · Oct 2009
Randomized Controlled TrialIntra-operative fluid warming in elective caesarean section: a blinded randomised controlled trial.
We assessed the effect of warming intravenous fluids during elective caesarean section under combined spinal-epidural anaesthesia in a blinded, randomised controlled trial. ⋯ Warming intravenous fluids mitigates the decrease in maternal temperature during elective caesarean section under combined spinal-epidural anaesthesia and improves thermal comfort, but does not affect shivering. Intravenous fluids should be warmed routinely in elective caesarean section, especially for cases of expected long duration, but the use of pre-warmed fluids is as efficient and cheaper than using a Hotline fluid warmer.
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Int J Obstet Anesth · Oct 2009
A retrospective one-year single-centre survey of obstetric red cell transfusions.
Fears about safety and availability of blood in the United Kingdom have prompted efforts to encourage evidence-based blood transfusion in all areas of medicine, with increasing interest in the obstetric population. A retrospective one-year single-centre audit of obstetric red cell transfusions was conducted. ⋯ Overall there appeared to be a low threshold for red cell transfusion, with 31% of transfusions occurring despite a haemoglobin >7 g/dL and in the absence of ongoing bleeding or symptoms of anaemia. Such transfusions are deemed inappropriate according to the Royal College of Obstetricians and Gynaecologists guidelines. The main recommendations are to implement an educational programme and guidelines in all obstetric units, reduce blood use and encourage documentation of appropriate consent.
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Int J Obstet Anesth · Oct 2009
Case ReportsDexmedetomidine for awake fiberoptic intubation in a parturient with spinal muscular atrophy type III for cesarean delivery.
Spinal muscular atrophy in pregnancy is rare and poses multiple problems for the anesthesiologist. The effects of dexmedetomidine on a parturient with spinal muscular atrophy have not previously been reported. There are also no in vivo data on placental transfer of dexmedetomidine and its effects on a human neonate. ⋯ Apgar scores at 1 and 5 min were 6 and 8. The fetal concentration of dexmedetomidine (540 pg/mL) indicates significant placental transfer, but significant adverse neonatal effects were not observed. Dexmedetomidine alone provided adequate sedation for awake intubation without respiratory compromise in this patient.