Anesthesiology clinics
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Although maternal mortality resulting from anesthesia is declining, airway causes predominate. Although there are many physiologic and nonphysiologic factors that contribute to potential difficulties when intubating parturients, whether or not the maternal airway is more difficult anatomically continues to be debatable. ⋯ Vigilance, avoidance, and preparation continue to be key to management. In cases of unexpected difficulty, which likely are unavoidable, several rescue devices may be helpful.
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Hypotension is a common, treatable side effect of neuraxial anesthesia, which has significant side effects for the mother and demonstrable biochemical effects in the fetus. It is clear that a shift in management of hypotension in the obstetric population is in order, but we can only speculate on the benefits for the compromised fetus due to the lack of available information in that patient population.
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Anesthesiology clinics · Mar 2008
ReviewUltrasound-facilitated epidurals and spinals in obstetrics.
Regional anesthesia is currently the gold standard of practice for pain control in obstetrics. Failures and complications of regional anesthesia can be related to many causes, one of the most important being the blind nature of such techniques. ⋯ The use of preprocedure ultrasound imaging or, eventually, real-time ultrasound guidance should improve not only clinical practice, but also teaching. This article describes the techniques, challenges, and benefits related to the use of ultrasound in guiding lumbar spinals and epidurals.
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Anesthesiology clinics · Mar 2008
Review Historical ArticleThe historical narrative: tales of professionalism?
The historical narrative is a story told to illustrate a point, however subconsciously. The "giants" of obstetric anesthesia -- Simpson, Snow, Apgar -- and countless other less well-known physicians all contributed to the history of obstetric anesthesia. ⋯ The Physician Charter is an excellent first approximation of a workable definition of this quality, which can and does change over time. By using the three principles and 10 professional responsibilities as a template, the past comes alive as a teaching method to each and every obstetric anesthesiologist.
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The peripartum management of the anticoagulated parturient represents a significant clinical challenge to both the obstetrician and the anesthesiologist. This review discusses the causes of thrombosis in the pregnant population, the anticoagulants used for prophylaxis, and treatment of these disorders, along with recommendations for neuraxial blockade in parturients who receive peripartum anticoagulation.