International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2006
Adnexal mass surgery and anesthesia during pregnancy: a 10-year retrospective review.
Many studies have addressed the specific perinatal risks of surgery and anesthesia during pregnancy, but there is still much undetermined. The objective of this retrospective review was to compare the adverse pregnancy outcome in patients undergoing laparoscopy and laparotomy with inhalational or regional anesthesia for adnexal mass in pregnancy. ⋯ Patients undergoing laparotomy with regional anesthesia for adnexal mass in pregnancy may have higher risk of preterm labor than those given general inhalational anesthesia for laparotomy or laparoscopy. Therefore, if regional anesthesia is used for this type of surgery, then precautions should be taken to reduce the risk of preterm labor.
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Int J Obstet Anesth · Apr 2006
Informed consent for labor epidurals: a survey of Society for Obstetric Anesthesia and Perinatology anesthesiologists from the United States.
Ethicists agree that informed consent is a process rather than just simply the signing of a form. It should provide the patient with needed information and understanding to authorize a procedure. Essential elements of informed consent for women requesting labor epidurals include a description of the procedure, the risks and benefits, and alternative treatments for analgesia including the associated risks and benefits. The purpose of this pilot study was to determine practices and opinions of obstetric anesthesiologists regarding informed consent for parturients. ⋯ Despite the painful, stressful circumstances confronted by parturients, many respondents (76% in academic, 64% in private practice) thought that women in active labor are able to give informed consent.
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Int J Obstet Anesth · Apr 2006
Case ReportsCoronary arterial air embolus occurring during cesarean delivery.
We present a case of a severe systemic (paradoxical) air embolism occurring during spinal anesthesia for cesarean delivery in an otherwise healthy 35-year-old parturient. Uncomplicated spinal anesthesia and satisfactory surgical anesthesia were obtained; no sedatives were used and the patient was awake and alert and tolerating the procedure well. Immediately following infant and placental delivery (approximately 25 min after the spinal anesthetic was induced) the patient had acute onset of markedly decreased mental status, profound ventricular ectopy and labile blood pressure. ⋯ Neurologic status returned to normal by the end of the surgery, but electrocardiogram findings in the immediate postoperative period were consistent with myocardial ischemia and serial cardiac troponin levels confirmed myocardial injury. On postoperative day 1, an echocardiogram demonstrated the presence of a patent foramen ovale. The events in this case are likely to be due to paradoxical coronary and cerebral air embolism.