International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2004
Comment Letter Comparative StudyEphedrine or phenylephrine to prevent or treat hypotension during spinal anaesthesia for caesarean section.
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Int J Obstet Anesth · Jul 2004
Case ReportsManagement of a parturient with paroxysmal nocturnal haemoglobinuria.
We present the case of a 30-year-old parturient diagnosed in the first trimester of her first pregnancy as having paroxysmal nocturnal haemoglobinuria. Pancytopenia necessitated regular transfusion of blood products. The risks of infection, haemorrhage and thrombosis, in the presence of severe thrombocytopenia, mild neutropenia and prophylactic anticoagulation, posed management challenges. ⋯ Severe thrombocytopenia proved a contraindication to regional techniques and she required general anaesthesia for evacuation of a retained placenta. The post-partum period was complicated by fever and a requirement for blood products. Management of these problems, of prophylactic anticoagulation and subsequent therapy, are discussed.
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Int J Obstet Anesth · Jul 2004
Demographic differences between consenters and non-consenters in an obstetric anesthesiology clinical study.
Willingness to participate in obstetric anesthesiology clinical studies may be influenced by age, parity or ethnicity. This study was designed to determine whether there were demographic differences between consenters and non-consenters in a minimum local analgesic concentration clinical study. Four hundred and fifty-two women were approached for the study and the age, ethnicity and parity of patients who consented or declined to participate were collected. ⋯ Black Americans were more likely to consent than Asian Americans (P<0.001) and as likely to consent as white Americans. There were no statistically significant differences in the consent rate between Caucasian and Asian Americans. More studies are needed to determine the socioeconomic and demographic factors that affect consent rates of labor patients.
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Int J Obstet Anesth · Apr 2004
Consent for regional anaesthesia in the United Kingdom: what is material risk?
Legal principles that apply to the process of informed consent have changed in recent years. Patients should now be given the information that they wish to receive, not the information that health professionals may consider reasonable for them. In obstetric practice informed consent is especially important as young, fit patients may request and receive non-essential but potentially life-threatening interventions. ⋯ Despite the availability of information for patients from sources such as the Obstetric Anaesthetists' Association and the National Electronic Library for Health, there remains little consensus amongst anaesthetists about what information to provide. Frequently some complications that patients would consider important are not discussed. Changing legal and public expectations demand that we adapt our current practice and improve the accuracy and timing of information provided.