Articles: outcome.
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J Stroke Cerebrovasc Dis · Jan 1995
Prognostic significance of ST-segment depression on continuous electrocardiography in patients with acute ischemic neurologic events.
Patients with a history of ischemic stroke or transient ischemic attack (TIA) are at significant risk of cardiac death. This study reports the prognostic significance of ST-segment depression and ventricular tachycardia on continuous electrocardiography in 48 consecutive patients hospitalized with an acute ischemic stroke or TIA. Thirty-one percent of patients had episodes of asymptomatic ST-segment depression and 6% had transient ventricular tachycardia on continuous electrocardiographic monitoring. ⋯ However, ventricular tachycardia was associated with a higher rate of cardiac death (33% vs. 2%, p < 0.01). Only 27% of patients subsequently found to have coronary artery disease had ST-segment depression by continuous electrocardiography. In contrast to patients with coronary artery disease, ST-segment depression on continuous electrocardiography is not associated with poorer outcome among patients with acute ischemic stroke or TIA.
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A case of anaphylaxis to a latex urethral catheter in a 33-year-old at full term pregnancy is presented. The diagnosis is based on clinical findings and supported by subsequent immunological tests. ⋯ Despite the good maternal outcome the child showed early signs of severe perinatal asphyxia, the long-term sequelae of which remain to be seen. This report discusses this unusual cause of anaphylaxis and highlights the problems of resuscitation in the pregnant patient.
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Int J Obstet Anesth · Apr 1994
Combined spinal epidural (CSE) analgesia: technique, management, and outcome of 300 mothers.
Epidural analgesia in labour is commonly associated with some degree of lower limb weakness often severe enough to be described as paralysis by the mother. We aimed to produce rapid reliable analgesia with no motor block throughout labour. We report a pilot survey of 300 consecutive women requesting regional analgesia in labour who received a combined spinal epidural blockade (CSE). ⋯ Transient hypotension occurred in 24 women (8%) and was treated with 6 mg intravenous boluses of ephedrine. Complete satisfaction with analgesia and mobility was reported 12-24 h post partum by 95% of mothers. The use of this analgesic technique caused no alteration in obstetric management or post partum care of the women.
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Int J Obstet Anesth · Jan 1993
Is opioid loading necessary before opioid/local anaesthetic epidural infusion? A randomized double-blind study in labour.
The effects of two different epidural loading doses administered before starting an opioid/low dose local anaesthetic infusion were examined in a randomized double-blind study during labour. Forty mothers were given either 10 ml 0.25% plain bupivacaine or 10 ml 0.125% plain bupivacaine containing 5 mcg of sufentanil followed in all cases by epidural infusion of 0.08% plain bupivacaine containing 0.2 mcg/ml of sufentanil, which was continued into the second stage. The quality of analgesia did not differ significantly between the groups in either the first or the second stage of labour: in each group 75% of women required 0 or 1 top-up during labour and verbal numerical pain scores were similar. ⋯ There was no difference in the degree of maternal satisfaction assessed 24 hours after delivery, with 80% of women in each group awarding the maximum verbal numerical score for their satisfaction with epidural analgesia. The incidence of maternal side effects (nausea, vomiting, drowsiness and pruritus) was similar in the 2 groups as was neonatal outcome, assessed by Apgar and neurological and adaptive capacity scores and umbilical artery and vein pH. We conclude that opioid loading before opioid/low-dose bupivacaine epidural infusions is unnecessary.
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Aneurysmal subarachnoid hemorrhage (ASAH) can cause sudden death from cardiorespiratory arrest (CRA). Successful resuscitation (SR) allows diagnosis and treatment of survivors. We studied incidences of CRA and the influence of SR in ASAH prognosis. ⋯ CRA is not infrequent after onset of ASAH and occurs more commonly in women with PCA. Most likely, it is due to a very large initial hemorrhage disrupting diencephalic circulatory and respiratory centers. Prognosis of patients suffering CRA from ASAH is dismal and not influenced by SR.