International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2009
Case ReportsProne positioning for ARDS following blunt chest trauma in late pregnancy.
After a road traffic accident a pregnant patient at 34 weeks of gestation developed ARDS following blunt chest trauma, for which she required mechanical ventilation. Twenty-four hours after the accident, ongoing severe hypoxaemia with atelectasis mainly in the dorsal parts of the lung led to the decision to manage the patient in the prone position. Prone positioning over 8h resulted in a persistent improvement of oxygenation, which allowed extubation the following day. ⋯ We have demonstrated that prone positioning can be used safely and effectively in a pregnant patient. It might be superior to other therapeutic options for improvement of oxygenation in pregnant patients. Careful positioning avoiding any external abdominal pressure and continuous fetal monitoring are mandatory.
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Int J Obstet Anesth · Jul 2009
Case ReportsCesarean section and primary pulmonary hypertension: the role of intravenous dexmedetomidine.
Primary pulmonary hypertension is a fatal disease that frequently becomes evident in pregnancy. The management of pregnant women with primary pulmonary hypertension poses a number of difficult problems, especially where regional anesthesia is considered to be contraindicated. A 30-year-old woman who developed primary pulmonary hypertension at 23 weeks of pregnancy was transferred to our hospital. ⋯ Intravenous dexmedetomidine was specifically used during emergence and recovery from anesthesia. This provided effective pain relief and hemodynamic stability. Throughout the clinical course, brain natriuretic peptide levels was monitored and used as an indicator of cardiac failure.
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Int J Obstet Anesth · Jul 2009
Randomized Controlled Trial Comparative StudyMinimum local analgesic concentrations of ropivacaine and levobupivacaine with sufentanil for epidural analgesia in labour.
Sufentanil is often added to ropivacaine and levobupivacaine to provide epidural analgesia in labour. The aim of this study was to compare the analgesic potencies of epidural ropivacaine and levobupivacaine in combination with sufentanil 0.5 microg/mL, using the minimum local analgesic concentration (MLAC) model with up-down sequential allocation. ⋯ When sufentanil 0.5 microg/mL was added to either ropivacaine or levobupivacaine for labour analgesia, no significant difference in analgesic potency was observed.