International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2008
Case ReportsAnesthetic management of labor in a patient with congenitally corrected transposition of the great arteries.
Laboring patients with congenitally corrected transposition of the great arteries present an interesting challenge to anesthesiologists because of the physiological changes that take place during pregnancy and the stress induced by labor. This paper describes the detailed management of a symptomatic parturient with congenitally corrected transposition of the great arteries. The patient was managed with epidural analgesia instituted early in labor with a continuous low-concentration infusion of local anesthetic and opioid but without an initial bolus. She underwent uneventful forceps-assisted vaginal delivery.
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Int J Obstet Anesth · Jan 2008
Case ReportsManagement of a parturient with thrombocytopenia-absent-radius syndrome undergoing urgent caesarean section.
Thrombocytopenia-absent-radius syndrome is a rare congenital condition characterised by a low platelet count and limb abnormalities. There may be airway difficulties and cardiac disease is frequently associated. ⋯ The major anaesthetic difficulties encountered were severe thrombocytopenia with a platelet count 30x10(9)/L, which precluded regional anaesthesia, and extensive limb abnormalities resulting in difficulty with vascular access and cardiovascular monitoring. Platelet transfusion was required but airway difficulties were not encountered.
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Int J Obstet Anesth · Jan 2008
Comparative StudyComparison of epidural analgesia with combined spinal-epidural analgesia for labor: a retrospective study of 6497 cases.
Combined spinal-epidural analgesia provides rapid-onset analgesia with minimal motor block, but it is a more invasive technique than epidural analgesia and the risk of complications may be increased. This study compared the safety and effect on delivery of combined spinal-epidural and epidural analgesia in labor. ⋯ We found that epidural and combined spinal-epidural analgesia were comparable in terms of safety, and had a similar effect on delivery type.
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Cardiac disease is one of the leading indirect causes of maternal mortality in the UK, exceeding numbers of direct deaths from thromboembolism and hypertension combined. Over one year in our unit we managed six women with coronary heart disease. In this series five women had stable coronary heart disease. ⋯ A multi-disciplinary approach was taken, with a collaborative plan made for each pregnancy and delivery. A thorough clinical history and examination together with transthoracic echocardiography allows risk stratification of women with coronary heart disease at risk of peripartum cardiac events. Further investigation specific to each woman's management can then be undertaken.