Anesthesiology clinics of North America
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Anesthesiol Clin North America · Mar 2003
ReviewMechanisms and management of an incomplete epidural block for cesarean section.
Epidural blockade is an important option for anesthesia in parturients undergoing abdominal delivery. Despite the multiple benefits of this method, there is at least one significant downside--a relatively high occurrence of unsatisfactory anesthesia that requires intervention. Depending on the presumed mechanism of epidural block failure and other clinically relevant factors (e.g., timing of diagnosis, urgency of the procedure, and so forth), certain effective measures are recommended to successfully manage this demanding situation. ⋯ When inadequate epidural block becomes apparent during surgery there are limited alternatives. Depending on the origin and the pattern of inadequate anesthesia, options may include psychological support, supplementation with a variety of inhalational and intravenous agents, and local anesthetic infiltration. Induction of general anesthesia is typically left as a backup option, but must be strongly considered if the patient continues to have pain/discomfort.
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Anesthesiol Clin North America · Mar 2003
ReviewPlanning for hemorrhage. Steps an anesthesiologist can take to limit and treat hemorrhage in the obstetric patient.
Obstetric hemorrhage continues to be a significant cause of maternal mortality and morbidity. Blood transfusion in such circumstances may be life saving but involves exposing the patient to additional risks. Limiting blood transfusion and using autologous blood when possible may reduce some of these risks. This article outlines the techniques that may be used to limit and more effectively treat hemorrhage in the obstetric patient, with particular attention paid to reducing the use of allogeneic blood transfusion.
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Anesthesiol Clin North America · Mar 2003
ReviewThrombocytopenia, low molecular weight heparin, and obstetric anesthesia.
The parturient with coagulation defects, whether related to thrombocytopenia or to anticoagulation therapy, presents a unique challenge to the anesthesiologist. The risk of spinal or epidural hematoma in these patients has not been quantified fully but is a factor that one must consider on a case-by-case basis in determining whether neuraxial anesthesia is appropriate for the parturient. Following the guidelines set forth in this article should help reduce the risk of spinal or epidural hematoma without sacrificing the quality of care provided to patients.
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Obstetric hemorrhage is still a significant cause of maternal morbidity and mortality. Prevention, early recognition, and prompt intervention are the keys to minimizing complications. Resuscitation can be inadequate because of under-estimation of blood loss and misleading maternal response. ⋯ A well-coordinated team is one of the most important elements in the care of a compromised fetus. If fetal anoxia is presumed, there is less than 10 minutes to permanent fetal brain damage. Antepartum anesthesia consultation should be encouraged in parturients with medical problems.
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Anesthesiol Clin North America · Mar 2003
ReviewBackache, headache, and neurologic deficit after regional anesthesia.
Back pain, chemical backache, PDPH, and neurologic deficit all may be reported after regional anesthesia for childbirth. Back pain is common during pregnancy, but epidural analgesia during labor does not increase the incidence of long-term back pain. Chemical backache caused by 2-chloroprocaine is probably a result of hypocalcemic tetany of paraspinous muscles. ⋯ Neurologic deficits after regional anesthesia are rare. Meticulous technique and vigilance are the keystones in avoiding major neurologic complications of regional anesthesia. Rapid diagnosis and appropriate treatment are essential to optimize a successful outcome if complications do develop.