International journal of obstetric anesthesia
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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
Case ReportsGeneral anaesthesia using remifentanil for caesarean section in parturients with critical aortic stenosis: a series of four cases.
Although heart disease is now the joint leading cause of maternal mortality in the UK, critical aortic stenosis is rarely encountered in parturients. Caesarean section is advisable in these patients to minimise the haemodynamic stress of labour and delivery. The use of an opioid-based general anaesthetic technique also helps to maintain cardiovascular stability. ⋯ Neonates were born in good condition with Apgar scores of 10, 9, 6 and 5 at 1 min and 10, 10, 10 and 10 at 5 min. We suggest that remifentanil is an ideal agent for parturients with severe aortic stenosis requiring general anaesthesia for caesarean section. Remifentanil provides cardiovascular stability in conjunction with rapid emergence from anaesthesia in the parturient and minimal side effects in the neonate.
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Int J Obstet Anesth · Jul 2004
Clinical TrialGeneral anaesthesia with target controlled infusion of propofol for planned caesarean section: maternal and neonatal effects of a remifentanil-based technique.
The present case series evaluated maternal and neonatal effects of remifentanil, combined with propofol, during general anaesthesia for caesarean delivery. Following written informed consent, ten patients scheduled for semi-elective caesarean section were recruited to this prospective, unblinded trial. All patients with non-reassuring fetal status were excluded. ⋯ We conclude that the results of the present case series using a remifentanil/propofol-based technique of general anaesthesia for caesarean section provide a basis to study the safety of this technique in a larger population. Under the conditions of the present trial, this anaesthetic technique seems safe for mother and infant, provided adequate precautions are taken to manage brief, self-limiting infant respiratory depression. At the moment we cannot advise the routine use of this technique, especially since it has not been studied in situations of fetal compromise.
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Int J Obstet Anesth · Jul 2004
Comparative StudyA comparison of cold, pinprick and touch for assessing the level of spinal block at caesarean section.
The sensory block levels of 102 women undergoing caesarean section under spinal anaesthesia were assessed by four different methods: sharp pinprick (Neurotip tester pin), cold (ethyl chloride spray), touch (Neurotip tester pin), touch (ethyl chloride spray). While the data indicate a median difference of some 2 segments between the levels of block assessed by sharp pinprick or cold, and touch, there was no constant relationship between these levels of block within the group nor within individual patients: variable and at times very large differences in the levels of block assessed among these modalities existed: up to 10 segments (pinprick - touch); 11 segments (cold - touch). ⋯ The results suggest that, for clinical purposes, there is no difference in outcomes whether Neurotip touch or ethyl chloride spray touch sensations are used. When using diamorphine 100 micrograms/mL mixed with bupivacaine 0.5% w/v in 8% dextrose, no patient felt any pain or discomfort provided the block to Neurotip or ethyl chloride touch sensations included T6 or above.
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Social Values, no less than medical science, have shaped the medical management of the pain of childbirth. Nineteenth century feminists fought for greater use of anesthesia in obstetrics at a time when physicians held back for fear of its effects on labor, hemorrhage, rates of infection and the condition of the child. A century later, after physicians became comfortable with the use of anesthesia, a new generation of feminists challenged the use of such drugs, once again citing social considerations. The personalities of colorful and charismatic obstetricians such as James Young Simpson and Grantley Dick-Read played a strong part in the outcome of each confrontation.