International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1994
Pregnancy and cirrhosis: management of hematemesis by Warren shunt during third trimester gestation.
Considerable pathophysiologic changes accompany cirrhosis. Elevation of portal venous pressure predisposes to esophageal varices and hematemesis. ⋯ The anesthetic management of a pregnant cirrhotic patient for a Warren shunt is complicated by concerns for pre-existing hepatic dysfunction and pregnancy-induced physiologic changes as well as fetal well-being. The management of such a case is reviewed and relevant pathophysiology discussed.
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Int J Obstet Anesth · Apr 1994
Low dose intrathecal morphine and pain relief following caesarean section.
Healthy women who underwent caesarean section under spinal anaesthesia were studied to determine the extent of postoperative analgesia and side-effects produced by low doses of intrathecal morphine. Patients were randomly allocated to receive, in double-blind fashion, 0 mg (group 1: control group), 0.05 mg (group 2), 0.1 mg (group 3), or 0.2 mg (group 4) of morphine, with 10 mg tetracaine in 10% dextrose 2.5 ml. (n = 20 x 4 groups). The effect of intrathecal morphine was examined in terms of the duration until the first supplemental analgesic was needed and the numbers of the doses within the first postoperative 48 h. ⋯ No patient developed respiratory depression. Our results suggest that postoperative analgesia lasts more than 24 h with 0.1 mg or 0.2 mg of intrathecal morphine. Since the incidence of side-effects was higher at 0.2 mg, 0.1 mg may be the optimum dose for caesarean section.
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Int J Obstet Anesth · Apr 1994
Continuous arteriovenous hemofiltration in the treatment of amniotic fluid embolism.
Continuous arteriovenous hemofiltration (CAVH) was successfully used in a 35-year-old woman, who had developed amniotic fluid embolism in the course of a premature labor and cesarean delivery. With CAVH, the pulmonary artery pressure decreased, the cardiac index rose, and the arterial oxygenation improved dramatically. This technique seems to be an important contribution to the management of amniotic fluid embolism.
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Continuous electrocardiographic monitoring was performed in 20 term parturients during labor, vaginal delivery, and recovery. Mean duration of monitoring was 13.37 h. ⋯ Eight patients exhibited premature ventricular contractions or supraventricular tachycardia. ST-segment depression was noted in 3 patients (15%); in all 3, this was concurrent with maximum heart rate, was not associated with any symptoms, and occurred in the post-partum period.
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Int J Obstet Anesth · Apr 1994
Awake fibre optic intubation in a 38-week pregnant patient with submandibular abscess.
A 38-week pregnant patient with trismus required surgery for drainage of a submandibular abscess. Her anaesthetic management involved an awake fibre optic intubation. We describe below the details of this and discuss the options for management of similar patients.