Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Mar 2017
ReviewSpinal-induced hypotension: Incidence, mechanisms, prophylaxis, and management: Summarizing 20 years of research.
Hypotension commonly occurs in parturients undergoing cesarean delivery under spinal anesthesia. This leads to maternal and neonatal adverse outcomes, including maternal nausea and vomiting and fetal acidosis, and might even lead to cardiovascular collapse if not treated. ⋯ Vasopressors are therefore the mainstay for the prophylaxis and treatment of spinal-induced hypotension. Phenylephrine is associated with improved neonatal acid-base status and a lower risk of maternal nausea and vomiting compared with ephedrine and is now considered the vasopressor of choice in obstetric patients. This review discusses the various strategies for managing spinal-induced hypotension with a particular emphasis on the optimal use of vasopressors.
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Best Pract Res Clin Anaesthesiol · Mar 2017
ReviewManaging major obstetric haemorrhage: Pharmacotherapy and transfusion.
Major obstetric haemorrhage is a leading cause of maternal mortality. A prescriptive approach to early recognition and management is critical to improving outcomes. Uterine atony is the primary cause of post-partum haemorrhage. ⋯ Early and empiric use of fixed transfusion red blood cell:plasma:platelet ratios is controversial and may not be justified for all causes of haemorrhage. Cell salvage may be used safely in obstetric haemorrhage. Goal-directed therapy using point-of-care testing (e.g. thromboelastography) has not been well studied but holds promise for individualising resuscitation measures.
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Best Pract Res Clin Anaesthesiol · Mar 2017
ReviewThe role of ultrasonography in obstetric anesthesia.
Ultrasonography is increasingly being viewed as an everyday tool in obstetric anesthesia. For the administration of spinal or epidural anesthesia, it reduces needle redirection attempts in patients with difficult anatomy. ⋯ Accurate assessment of gastric volume status with ultrasound would be a useful everyday skill if it is adopted into mainstream practice. We provide a summary of current opinions on the role of ultrasound in practice and highlight the potential for its future use in obstetric anesthesia.