International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2009
Multicenter StudyThe impact of a teaching program on obstetric anesthesia practices in Croatia.
Many countries fail to use regional techniques for either labor analgesia or obstetric anesthesia. Kybele, an international outreach group, seeks to improve obstetric anesthesia practices worldwide. Its educational program in Croatia was evaluated by studying the change in use of regional anesthetic techniques in obstetrics after a Kybele visit. ⋯ In Croatia, a two-week educational program in obstetric anesthesia increased the use of regional anesthesia and analgesia for labor and delivery in the year that followed the program. Multiple factors limit availability of analgesia for childbirth in Croatia.
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Int J Obstet Anesth · Jan 2009
Randomized Controlled TrialA randomized study of maternal serum cytokine levels following cesarean section under general or neuraxial anesthesia.
Cytokines are significant mediators of the immune response to surgery and also play a role in parturition. The aim of the study was to investigate the impact of the anesthetic technique for cesarean section on plasma levels of cytokines IL-6 and TNF-alpha. ⋯ Under the present study design anesthetic technique did not affect IL-6 or TNF-alpha concentrations in parturients undergoing elective cesarean section. Serum IL-6 levels increased 24 h postoperatively independently of anesthetic technique.
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A primigravid woman suffered a prolonged cardiac arrest at 18 weeks of gestation. Dilated ischemic cardiomyopathy was diagnosed. After recovery, the patient received an implantable cardioverter-defibrillator. ⋯ The effect of pregnancy on underlying cardiac disease and the management of maternal cardiac arrest with a pre-viable fetus are discussed. The importance of a multidisciplinary approach is emphasized. Continued neurodevelopmental assessment of the newborn is necessary to detect the long-term effects of fetal hypoxia in early pregnancy.
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Int J Obstet Anesth · Jan 2009
Inadequate pain relief with labor epidurals: a multivariate analysis of associated factors.
Labor epidural analgesia providing inadequate pain relief may cause maternal dissatisfaction and may fail to produce effective anesthesia when topped up for operative delivery. This study looked at factors associated with inadequate labor epidural analgesia. ⋯ The final model correctly classified 93% of the epidurals that provided effective analgesia but classified only 9.3% of those providing inadequate pain relief. This information can be used to develop a predictive score and change practice resulting in fewer inadequate epidurals.
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Int J Obstet Anesth · Jan 2009
Case ReportsEpidural analgesia in labor for a woman with an intrathecal baclofen pump.
A 28-year-old woman in active labor at 38 weeks of gestation requested epidural analgesia. She had previously received an intrathecal baclofen infusion pump to relieve the spasticity of cerebral palsy. She had right hemiparesis and cerebral palsy but was otherwise healthy. ⋯ For labor analgesia the epidural space was identified at L4-5 with the patient sitting, using a standard 17-gauge Tuohy needle. An epidural catheter was threaded to 5 cm and provided effective analgesia until delivery four hours later. There were no postnatal complications.