International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1996
Discomfort associated with regional anesthetic placement in obstetrics: does alkalinization help?
Lidocaine is commonly used prior to intravenous catheter insertion as well as before instituting a regional anesthetic[ but it often causes a burning discomfort during injection. We undertook this study to determine if the addition of bicarbonate to lidocaine would decrease the discomfort associated with the initiation of regional anesthesia in obstetrics. Forty patients who were scheduled for elective cesarean section or who were in active labor were selected. ⋯ Pain was assessed using visual analog scales on three occasions, immediately after lidocaine placement, following introducer needle insertion (in the spinal group) or following epidural needle insertion (in the epidural group), and following the successful placement of the local anesthetic (in the spinal group) or the epidural catheter (in the epidural group). There was no difference in the visual analog scale scores at any of the assessment periods. We found no benefit from adding sodium bicarbonate to lidocaine used for infiltration before needle placement when initiating an obstetrical regional anesthetic.
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Int J Obstet Anesth · Apr 1996
The role of serotonin in preeclamptic hypertension. A review and case report.
Generalized arteriolar vasospasm and subsequent damage to vascular endothelium are fundamental to the development of preeclampsia. A possible mechanism underlying this involves increased deportation of trophoblast cells into maternal venous circulation with 5-hydroxytryptamine (serotonin, 5-HT) release as a consequence of platelet aggregation onto these fragments. Ketanserin, a 5-HT(2) receptor blocker, has been used successfully to treat preeclampsia. An examination of the therapeutic role of ketanserin indicates that there should now be a much more detailed assessment of serotonin antagonists in the treatment and prophylaxis of preeclampsia and eclampsia.
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Haemoglobin concentration is measured routinely before caesarean section in many obstetric units. It is also measured early in the third trimester in order to screen for anaemia. We investigated the hypothesis that when the haemoglobin concentration was normal in the early third trimester, a repeat measurement immediately before surgery at term provided no useful additional information. ⋯ Peri-operative management at term may therefore be guided by the haemoglobin concentration measured early in the third trimester. There appears to be no clinically significant change in haemoglobin during this time and there are physiological changes in the circulation that explain this effect. Discontinuation of routine pre-operative haemoglobin concentration measurement could lead to a significant financial saving.
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Int J Obstet Anesth · Apr 1996
Critically ill parturient women and admission to intensive care: a 5-year review.
Thirty-nine parturient women were admitted to a general intensive care unit (ICU) from April 1989 to March 1994 and of these four were readmitted (total 43 admissions). Twelve women were admitted to the obstetric unit from peripheral hospitals in different regions, but no requirement for intensive care was perceived on referral. Six women were transfered directly into the intensive care unit from different hospitals in the region. ⋯ A multidisciplinary approach to management is practised and specialist interventions included haemofiltration and haemodialysis (18%) and radiological arterial embolisation (10%). Ventilatory and inotropic support were given in 38% and 41% of patients respectively. Only one patient died on the intensive care unit, this was from multiorgan failure secondary to sepsis.
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Rupture of splenic artery aneurysm should be considered in the differential diagnosis of collapse occurring during pregnancy or in the puerperium. It is a relatively rare condition with a high mortality in which lives could be saved by prompt diagnosis and treatment. Anaesthetists and obstetricians should be aware of this because 20-50% of all ruptures occur during pregnancy. We describe two cases and discuss the epidemiology, aetiology and management of this condition.