International journal of obstetric anesthesia
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Substance abuse, including that of cocaine, has crossed social, economic and geographic borders and remains one of the major problems facing society today. The prevalence of cocaine abuse in young adults (including women) has increased markedly over the past two decades. ⋯ The diverse clinical manifestations of cocaine abuse combined with physiologic changes of pregnancy, and pathophysiology of coexisting pregnancy-related disease might lead to life-threatening complications and significantly impact the practice of obstetric anesthesia. A complete understanding of the physiology of pregnancy, pathophysiology of pregnancy-specific disorders and anesthetic implications of cocaine abuse in pregnancy is essential to tailor a safe anesthetic plan for this high-risk group of patients.
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Int J Obstet Anesth · Apr 2002
Epidural catheter function during labor predicts anesthetic efficacy for subsequent cesarean delivery.
One of the benefits of labor epidural analgesia is that the catheter can be used to initiate a surgical block should the need for cesarean delivery arise. However, sometimes it is not possible to obtain adequate surgical anesthesia via a previously placed labor epidural catheter and it is unknown what factors are associated with this failure. We retrospectively investigated the incidence of failure to convert a labor epidural to a successful surgical block in our institution over a period of one year and determined the factors associated with this failure. ⋯ Factors associated with failure of the epidural block were an increased requirement for supplemental local anesthetic boluses during labor in order to provide adequate analgesia and that the attending anesthesiologist for the cesarean delivery was not a specialist in obstetric anesthesia. Most epidural catheters placed for labor can be used to induce a surgical block. When significantly more local anesthetic than usual is required to maintain analgesia during labor, however, the epidural catheter may not be functioning properly and consideration should be given to replacing it.
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Int J Obstet Anesth · Apr 2002
Clinical experience with cell salvage in obstetrics: 4 cases from one UK centre.
We present 4 cases in which cell salvaged blood was used in maternity patients, including three caesarean sections and one post-partum haemorrhage. All patients were monitored for a minimum of 24 h on either a general Intensive Care Unit (ICU) or specialised obstetric High Dependency Unit (HDU). ⋯ Cell salvage in obstetrics is being used in a haphazard and individual manner and our only present outcome indicators are case reports. We consider the argument for and against cell salvage in obstetrics, and suggest guidelines to reflect current best practice in the use of the machine and filters.
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Int J Obstet Anesth · Apr 2002
Postpartum neurological symptoms following regional blockade: a prospective study with case controls.
We undertook a 12-month prospective study to establish the incidence, nature and significance of postpartum neurological symptoms. To explore the effects of regional blockade, obstetric intervention and neurological examination, women with symptoms after regional blockade were matched with two asymptomatic case controls, one with similar regional blockade and obstetric intervention and another without either regional blockade or obstetric intervention. Twenty-two of 2615 women who had received regional blockade and one of 1376 who had not, presented with postpartum neurological symptoms (incidence 5.8:1000). ⋯ Sixteen women who had presented with symptoms completed a 6-month follow-up interview. Thirteen had no symptoms and three had residual sensory symptoms but no functional impairment. These results confirm that postpartum neurological dysfunction is more frequent if specifically sought, and support the clinical impression that significant neurological deficits occur irrespective of the use of regional anaesthesia.
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Int J Obstet Anesth · Apr 2002
Randomized Controlled Trial Clinical TrialHigh-dose diclofenac for postoperative analgesia after elective caesarean section in regional anaesthesia.
Although the use of non-steroidal anti-inflammatory drugs (NSAIDs) is well established in the postoperative setting, their use after caesarean sections is still controversial. In a randomised, double-blinded, placebo controlled study we have estimated the opioid-sparing effect of diclofenac suppositories after elective caesarean sections in spinal anaesthesia. Eighty-two women ASA class I or II scheduled for caesarean section were randomised to receive either diclofenac suppositories 100 mg or placebo every 12 h after the operation. ⋯ The average level of postoperative pain as estimated by a visual analogue scale (VAS) and a verbal scale tended to be lower in the diclofenac group, but this was not significant. There were no differences in demographic data, perioperative bleeding, side-effects or discharge time between the groups. Diclofenac suppositories 100 mg given twice daily after caesarean section are opioid sparing.