Masui. The Japanese journal of anesthesiology
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The incidence of intracranial hemorrhage is approximately 1-5 in 10,000 pregnancies. In Japan, it is reported that 184 such cases occurred and 10 of them died in 2006. Neurosurgery during pregnancy is required infrequently however a multidisciplinary approach is mandated and anesthesiologists need to modify neuroanesthetic and obstetric practices to accommodate the safety requirements of the mother and fetus. Following the physiologic changes of pregnancy and fetal considerations in nonobstetric surgery during pregnancy, we present the maternal and fetal considerations in anesthesia for intracranial hemorrhage.
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Although, general anesthesia for cesarean section still seems to be the method of choice in extremely urgent settings, past anesthetic evidence has shown that general anesthesia is with increased risk of anesthesia-related maternal mortality. The major disadvantage with general anesthesia is the risk of aspiration of gastric contents and a "cannot ventilate, cannot intubate" situation. ⋯ This review examines the recent knowledge of these topics. We also describe the benefits and risks of new drugs, such as propofol, remifentanil and rocuronium in general anesthesia for cesarean section.
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Maternal mortality rate in Japan decreased dramatically in the last 50 years. It reached 3.2, one of the lowest in the world. ⋯ Uterine displacement, deeper chest compressions, and early tracheal intubation are essential. Emergency cesarean delivery should be considered as soon as a pregnant woman develops cardiac arrest.
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The trial of labor analgesia in Japan dates back to the year 1929. After the foundation of the original Japan Society of Obstetric Anesthesia and Perinatology in 1961, various labor analgesia techniques were widely attempted. Some anesthetists relieved the labor pain with balanced anesthesia using intravenous (diazepam and pethidine during the 1st stage of labor, followed by pentobarbital or ketamine during the 2nd stage of labor) combined with inhalational anesthetic (methoxyflurane or enflurane), while the others tried regional anesthesia. ⋯ However, the ideal labor analgesia technique has been still controversial. We, obstetric anesthesiologists, should grope for safer and more comfortable anesthetics to the mother and fetus. In next 50 years, the standard method for labor analgesia may change to no needle system with non-placental transfer anesthetics.
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A 26-year-old G1P0 woman with past history of bronchial asthma underwent emergency cesarean section for non-reassuring fetal status under spinal anesthesia. She had not had surgery before. Thirteen minites after the start of the procedure, she started complaining of flushing and itching of her hands and mouth. ⋯ It is known that several antigens which cause latex allergy share common structures with defense related proteins of plants. It is to be noticed that, patients sensitized by those defense related proteins by plants intake, may develop latex allergy even though they are not considered to be high risk group from relevant occupational exposure and, co-morbid conditions. We should consider latex allergy as one of the causes of shock during intraoperative period even when the possibility of latex allergy seems scant.