International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2009
Anaesthesia mode for caesarean section and mortality in very preterm infants: an epidemiologic study in the EPIPAGE cohort.
Little is known about the influence of anaesthesia for caesarean section on outcome in very preterm infants. ⋯ In this population-based study, spinal anaesthesia was associated with an increased risk of neonatal mortality in very preterm infants compared to general anaesthesia (and epidural anaesthesia), independently from gestational age and characteristics of the pregnancies, deliveries and neonates. Although this multivariate analysis does not prove a causal relationship, the results suggest it could exist, particularly if maternal haemodynamics are poorly controlled. With recent significant change in the conduct of spinal anaesthesia, further studies are needed to investigate potential harmful effects of anaesthesia on very preterm infants delivered by caesarean section.
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Int J Obstet Anesth · Apr 2009
Randomized Controlled TrialAnaesthesia for caesarean section in women with complex cardiac disease: 34 cases using the Braun Spinocath spinal catheter.
Cardiac disease in pregnancy is now the leading medical cause of maternal mortality in the UK. Whilst anaesthesia has not been the precipitant of this morbidity, its safety cannot be taken for granted. Spinal catheter anaesthesia, a relatively uncommon choice in obstetric practice, offers the potential of maintaining haemodynamic stability through accurate and gradual titration of neuraxial blockade. ⋯ Incremental spinal catheter anaesthesia offers effective anaesthesia with excellent haemodynamic control. Post dural puncture headache is of concern, and whilst it may be addressed by product modification, it currently limits widespread use of the Braun Spinocath in obstetric practice.
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Int J Obstet Anesth · Apr 2009
Clinical TrialThe effects of meperidine and epidural analgesia in labor on maternal heart rate variability.
Epidural and parenteral opioid analgesia are two common methods of pain relief in labor that may influence the autonomic nervous system. However, these effects on laboring women have not yet been adequately studied. The aim of our study was to assess the effects of these two methods of analgesia on autonomic nervous system modulation of maternal heart rate variability in laboring women. ⋯ Meperidine caused an autonomic nervous system shift towards sympathetic activation with abolition of respiratory sinus arrhythmia high-frequency spectral band. Conversely epidural analgesia had no significant effect on autonomic nervous system control of heart rate.
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Int J Obstet Anesth · Apr 2009
Case ReportsAnaesthetic management of parturients with hereditary haemorrhagic telangiectasia for caesarean section.
Hereditary haemorrhagic telangiectasia, also known as Osler-Weber-Rendu disease, is a vascular disorder characterized by multiple mucocutaneous and visceral arteriovenous malformations. There is little in the literature about the anaesthetic management of parturients with this condition. ⋯ The second patient had general anaesthesia because investigations could not rule out neurological involvement. We review and discuss the anaesthetic considerations for obstetric patients with hereditary haemorrhagic telangiectasia.
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Int J Obstet Anesth · Apr 2009
Case ReportsAntenatal blood patch in a pregnant woman with spontaneous intracranial hypotension.
Spontaneous intracranial hypotension is a condition that presents with postural headaches similar to those caused by accidental dural puncture. The diagnosis is based on clinical presentation, cerebrospinal fluid evaluation and magnetic resonance imaging scanning. ⋯ The blood patch, performed at 32 weeks of gestation, produced transient improvement in symptoms but failed to completely cure the headache, which worsened over the next few days. Symptoms resolved over the subsequent three weeks with conservative therapy.