International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2009
Case ReportsAnesthetic management for cesarean delivery in a parturient with exacerbated hemophagocytic syndrome.
Hemophagocytic syndrome is an uncommon disease characterized by cytokine dysfunction and uncontrolled hemophagocytosis. It arises rarely during pregnancy, in which case maternal and fetal mortality are relatively high. It has some similarities with HELLP syndrome. ⋯ General anesthesia was provided successfully for cesarean delivery. The patient recovered completely after this episode. We suggest that early diagnosis, multi-disciplinary intervention, pre-operative correction of the hematological abnormalities, general anesthesia and close postoperative monitoring are necessary.
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Int J Obstet Anesth · Oct 2009
A survey of the management of spinal-induced hypotension for scheduled cesarean delivery.
Intravenous fluids and vasopressors are used for managing spinal-induced hypotension during cesarean delivery, but the choice of vasopressor and the type and timing of fluid administration remain controversial. ⋯ Significant variations in practice exist in the prevention and treatment of spinal-induced hypotension. Fluid preloading and the prophylaxis and treatment of hypotension with ephedrine continue to be common practices.
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Int J Obstet Anesth · Oct 2009
Case ReportsAcupuncture in the management of post-partum headache following neuraxial analgesia.
Women presenting with low pressure post-partum headache following neuraxial techniques are frequently offered an epidural blood patch, despite its inherent risks. We present two parturients with classical symptoms of low-pressure headache, who each received neuraxial labour analgesia without a documented dural puncture with a Tuohy needle. Both parturients were successfully managed using acupuncture rather than an epidural blood patch.
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Failed intubation is relatively common in the obstetric patient. Overall, there has been a decline in experience of general anaesthesia in obstetrics. The level of anaesthetic preparedness in the event of a difficult obstetric intubation is unknown. ⋯ Essential airway equipment was readily available in the event of a difficult obstetric intubation, with the exception of a fiberoptic bronchoscope. Few units conduct difficult airway training.
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Int J Obstet Anesth · Oct 2009
Editorial CommentBlood transfusions: more is not necessarily better.