Anesthesiology clinics
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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.
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Infection is the commonest cause of serious neurologic sequelae of neuraxial anesthesia. The incidence depends on operator skill and patient population. Meningitis, a complication of dural puncture, is usually caused by viridans streptococci. ⋯ Epidural abscess is a complication of epidural catheterization, route of entry the catheter track and the organism usually the staphylococcus. Principal risk factors are prolonged catheterization, poor aseptic technique and traumatic insertion. Prevention includes wearing a mask, using a full sterile technique, avoiding prolonged catheterization and prescribing antibiotics in a high-risk situation.
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Maternal deaths in developed countries continue to decline and are rare. Maternal mortality statistics are essentially similar in the United States and United Kingdom. However, the situation is completely different in developing countries, where maternal mortality exceeds 0.5 million every year. This article not only assesses morbidity risks in some of the leading causes of maternal death but also highlights strategies to minimize the risks and to prevent maternal morbidity and mortality.