International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2004
Comparative StudyIn vitro evidence of gender-related heparin resistance.
Coagulability varies among men, women, and pregnant women, along a spectrum where the blood of men is the least and that of pregnant women the most coagulable. The effects of differences in coagulation status on the action of heparin cannot be measured by specific laboratory tests such as aPTT or anti-Factor Xa assay. Thromboelastography which measures whole blood coagulation can assess the effect of heparin against differing backgrounds of coagulation. ⋯ Across the subject groups, from men to pregnant women, increasing coagulability was seen, with shortening of r and k (P < 0.04), and increasing angle and MA (P < 0.0001). A relationship between gender and heparin was significant for r and k (P < 0.02) but not for angle and MA. This result assists the case against a one-size-fits-all approach to policies on heparinisation.
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Int J Obstet Anesth · Apr 2004
Case ReportsVery low-dose spinal anesthesia for cesarean section in a morbidly obese preeclamptic patient and its potential implications.
To our knowledge, based on a literature search, this is the first case report of successful cesarean section requiring a very low total dose of 5 mg hyperbaric spinal bupivacaine without any spinal or intravenous supplements in a morbidly obese (BMI=66 kg/m(2)) preeclamptic parturient. This parturient appeared to be more sensitive than the average to spinal anesthesia for cesarean section. ⋯ This report does not suggest the routine use of low-dose spinal anesthesia without supplements, but illustrates the wide variability in dosage and sensitivity to spinal anesthetics, and suggests that further research is needed in this area, particularly in morbidly obese parturients. Furthermore, it emphasizes the importance of vigilance and frequent blood pressure and respiration monitoring even in cases of low-dose spinal analgesia, such as that used in the combined spinal-epidural technique for labor analgesia.
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Int J Obstet Anesth · Apr 2004
Comment Letter Case ReportsInadequate spinal anaesthesia with 0.5% Marcain Heavy (Batch 2016).
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We conducted a retrospective review of obstetric patients admitted to the intensive care unit at Al-Ain hospital during period January 1(st) 1997 to December 31(st) 2002, in order to identify the indications for admission and the outcome. A total of 60 patients were admitted during the six years. The frequency of admission was 2.6 per 1000 deliveries and obstetric patients represented 2.4% of all ICU admissions. ⋯ The mean APACHE II score and duration of stay were significantly higher in these patients. There were two deaths, representing 3.3% of obstetric intensive care unit admissions. Our findings highlight the need for establishing a high dependency unit to avoid unnecessary admission to the intensive care unit and to ensure proper management.