MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'International Journal of Obstetric Anesthesia' source. Tue, 02 Mar 2010 13:42:50 +0100 http://www.medworm.com/index.php?rid=3097570&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X0900199X%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097570 Fri, 18 Dec 2009 13:42:08 +0100 3097570 http://www.medworm.com/index.php?rid=3097532&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001964%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097532 Fri, 18 Dec 2009 13:41:57 +0100 3097532 http://www.medworm.com/index.php?rid=3097533&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001794%2Fabstract%3Frss%3Dyes The prevalence of chronic pain in our society reaches 35%, higher in women than men (40% vs. 31%). Looking at risk factors associated with chronic pelvic pain in the female population, a history of gynecological surgery and more particularly previous cesarean delivery is frequently highlighted. Indeed, 20% of the patients seen in pain clinics report that a surgical procedure caused their pain. Thanks to several publications over the last decade, chronic pain is now recognized as an important outcome of surgery and a prevalent healthcare problem. However, it is of interest that the first paper on persistent pain after the most common operation worldwide, i.e. cesarean delivery, was published as recently as 2004. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097533 Thu, 03 Dec 2009 00:00:00 +0100 3097533 http://www.medworm.com/index.php?rid=3097536&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000545%2Fabstract%3Frss%3Dyes Conclusion: The results indicate that women experience similar pain and analgesic requirements after scheduled compared to unplanned cesarean delivery. This suggests that the non-scheduled cesarean population may be a suitable pain model to study pain management strategies; and that alterations in pain management are not necessary for the unplanned cesarean delivery population. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097536 Wed, 02 Dec 2009 00:00:00 +0100 3097536 http://www.medworm.com/index.php?rid=3097569&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001897%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097569 Mon, 30 Nov 2009 00:00:00 +0100 3097569 http://www.medworm.com/index.php?rid=3097568&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001496%2Fabstract%3Frss%3Dyes Osteogenesis imperfecta (OI) is an inherited connective tissue disorder with an expression that varies from mild to severe disease affecting bone, sclera and middle ear. A 24-year-old nulliparous woman with type-III OI was transferred to our obstetric unit from another hospital at 22 weeks of gestation. She was referred to our high-risk obstetric anaesthetic clinic and seen at 26 weeks. She had been diagnosed with OI in infancy and suffered multiple bone fractures, with the exception of her skull, mandible and vertebral column, in childhood. She had not sustained fractures in the past seven years. General anaesthesia had previously been administered without complication. Her weight was 25kg and her height 91cm (BMI 30.1kg/m); she was confined to a wheelchair. Cardiovascular examination was... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097568 Mon, 30 Nov 2009 00:00:00 +0100 3097568 http://www.medworm.com/index.php?rid=3097567&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001460%2Fabstract%3Frss%3Dyes Severe neurological deficit following spinal anaesthesia is extremely rare, with a behavioural aetiology most unusual. A fit 37-year-old G3 P2 Caucasian female presented for caesarean section. Her medical history included malaria and a caesarean section under spinal anaesthesia three years previously in our institution. She lived in Africa and worked as a teacher. Preoperative assessment was unremarkable although she confessed that her mood was different during this pregnancy. Coagulation screen was normal and she tested negative for HIV and syphilis. The same anaesthesiologist present at her previous caesarean section performed an uncomplicated spinal anaesthetic consisting of hyperbaric bupivacaine 12.5mg, morphine 150μg and sufentanil 2.5μg injected at the L4-5 interspace using a 25-g... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097567 Mon, 30 Nov 2009 00:00:00 +0100 3097567 http://www.medworm.com/index.php?rid=3097566&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001447%2Fabstract%3Frss%3Dyes We would like to thank Dr Russell for his interesting letter about our study. We agree with his comments about the influence of pregnancy and venous engorgement on spinal anesthesia and the effect of positioning during and after local anesthetic administration. The spread of subarachnoid local anesthetics is clearly greater in pregnancy due to these changes. Our hypothesis was that reduced cerebrospinal fluid volume resulting from venous engorgement within the spinal canal might lead to increased difficulty inserting a spinal catheter. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097566 Mon, 30 Nov 2009 00:00:00 +0100 3097566 http://www.medworm.com/index.php?rid=3097565&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001459%2Fabstract%3Frss%3Dyes Two aspects of the study of continuous spinal anaesthesia (CSA) for caesarean section by Alonso and colleagues deserve comment. Despite excluding technical failures, the authors observed a high failure rate (12/94) when even 15 mg of bupivacaine with fentanyl 20μg did not result in the desired level of block: T4 to cold. Fifteen milligrams of bupivacaine is well above the ED 95 (13.6 mg) for attaining a T5 block to touch with a single-shot spinal. Bearing in mind that a block to cold will be several dermatomes higher than a block to touch, this suggests that, compared to a single-shot spinal, the CSA technique inhibits the spread of spinal anaesthesia. The authors discussed two possible causes for this, catheter position and narrowing of the subarachnoid space due to venous engorgement. T... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097565 Mon, 30 Nov 2009 00:00:00 +0100 3097565 http://www.medworm.com/index.php?rid=3097564&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001435%2Fabstract%3Frss%3Dyes Parturients present well described, specific problems with airway management. Moreover, it is not uncommon for obstetric suites to be sited away from the main operating rooms (ORs), as in our institution, necessitating a separate difficult airway cart. Because of the potential for airway problems in this remote location, we decided to obtain a GlideScope® videolaryngoscope for use in the obstetric suite. This decision proved to be fortunate, as we recently made urgent use of the GlideScope® in two patients in one day. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097564 Mon, 30 Nov 2009 00:00:00 +0100 3097564 http://www.medworm.com/index.php?rid=3097563&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001411%2Fabstract%3Frss%3Dyes Ketamine, in sub-anaesthetic doses, has been shown to provide acceptable intra- and postoperative analgesia. We conducted a preliminary, prospective trial to assess the efficacy and safety of a low-dose ketamine infusion for labour analgesia. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097563 Mon, 30 Nov 2009 00:00:00 +0100 3097563 http://www.medworm.com/index.php?rid=3097562&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001393%2Fabstract%3Frss%3Dyes While the incidence of pressure ulcers in general hospital patients is well documented at 4-10%, there are only a few published case reports relating to the obstetric population, in whom, anecdotally, the incidence seems to be rising. In 2000 Morrison and Baker reported a local incidence of 0.15%. In our unit in the last year the incidence was 0.2%. Although infrequent, pressure ulcers are not only distressing to the mother, who is unable to sit down and breast feed her newborn, they can also lead to litigation against hospitals on the grounds of poor nursing care. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097562 Mon, 30 Nov 2009 00:00:00 +0100 3097562 http://www.medworm.com/index.php?rid=3097561&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001368%2Fabstract%3Frss%3Dyes We present a case of PONV following intrathecal morphine for cesarean delivery, that was resistant to treatment with multiple agents, but responded to a low-dose naloxone i.v. infusion. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097561 Mon, 30 Nov 2009 00:00:00 +0100 3097561 http://www.medworm.com/index.php?rid=3097560&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001332%2Fabstract%3Frss%3Dyes Women from ethnic minorities in the UK are known to have a higher risk of dying during pregnancy, and of certain complications such as type-2 diabetes. Communication with women who do not speak English requires specific facilities and materials. The Obstetric Anaesthetists’ Association (OAA) has produced translations of its patient information booklets. We wished to gain information on the languages that should be given priority for further translations, and therefore conducted a postal survey of the 235 UK lead obstetric anaesthetists on the OAA database. We asked respondents to list the five languages most commonly requiring the services of an interpreter in their obstetric population. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097560 Mon, 30 Nov 2009 00:00:00 +0100 3097560 http://www.medworm.com/index.php?rid=3097559&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001320%2Fabstract%3Frss%3Dyes We read with interest the article by Van de Velde et al. and would like to congratulate them on their work. As the authors point out, opposers of routine combined spinal-epidural (CSE) analgesia for labour argue that deliberate dural puncture leads to a significant increased risk of post-dural-puncture headache (PDPH). After analysing data from over 16 000 CSEs, Van de Velde et al. conclude that CSE does not seem to alter the risk of accidental dural puncture or PDPH compared to previous studies. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097559 Mon, 30 Nov 2009 00:00:00 +0100 3097559 http://www.medworm.com/index.php?rid=3097558&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001769%2Fabstract%3Frss%3Dyes Abstract: A 35-year-old G2P1 parturient at 32 weeks of gestation with an implanted spinal cord stimulator was admitted for urgent caesarean section. Spinal anaesthesia was performed below the spinal cord stimulator leads at the L4-5 level, and a healthy female infant was delivered. A basic description of the technology and resulting implications for the parturient are discussed. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097558 Mon, 30 Nov 2009 00:00:00 +0100 3097558 http://www.medworm.com/index.php?rid=3097557&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001484%2Fabstract%3Frss%3Dyes We present the case of an obstetric patient with unintentional subdural catheter placement that presented as a failed epidural block associated with severe upper back and scapular pain on catheter injection. Electrical stimulation of the catheter did not elicit muscle contractions until a current of 4 mAmp was attained, which is the response pattern of epidural placement. Subdural location of the catheter was subsequently confirmed by contrast radiography. This case adds to the evidence that subdural catheters are difficult to identify clinically, and that electrical stimulation may not differentiate them from epidural catheters. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097557 Mon, 30 Nov 2009 00:00:00 +0100 3097557 http://www.medworm.com/index.php?rid=3097556&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001502%2Fabstract%3Frss%3Dyes Abstract: A 26-year-old primiparous patient with intractable benign intracranial hypertension treated by cerebrospinal fluid drainage through an indwelling spinal catheter was expecting twins. At 30 weeks she presented for emergent cesarean delivery secondary to a non-reassuring fetal condition. In consultation with the neurosurgical team, spinal anesthesia for the cesarean delivery was induced successfully through the spinal catheter. Cesarean delivery proceeded uneventfully with a favorable neonatal outcome. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097556 Mon, 30 Nov 2009 00:00:00 +0100 3097556 http://www.medworm.com/index.php?rid=3097555&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001381%2Fabstract%3Frss%3Dyes We report the anesthetic management of a young woman with cleidocranial dysplasia undergoing four caesarean sections, one vaginal delivery and a dilatation and curettage, employing different modes of anesthesia. Anesthetic management in this disorder presents challenges for both general and neuraxial anesthesia. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097555 Mon, 30 Nov 2009 00:00:00 +0100 3097555 http://www.medworm.com/index.php?rid=3097554&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001241%2Fabstract%3Frss%3Dyes We describe a woman who presented at 20 weeks of gestation with acute heart failure due to cor triatriatum, a rare form of congenital heart disease. This condition is characterized by a perforated fibromuscular membrane dividing the left atrium into two chambers. The clinical presentation varies from asymptomatic to acute heart failure depending on the size of the fenestrations in the membrane and the presence of associated cardiac malformations. In our patient, two severely restrictive orifices in a membrane within the left atrium, moderate to severe pulmonary hypertension and good biventricular function were demonstrated by transthoracic echocardiography. Without surgical resection, the increased blood volume and cardiac output associated with pregnancy could have resulted in cardiovascu... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097554 Mon, 30 Nov 2009 00:00:00 +0100 3097554 http://www.medworm.com/index.php?rid=3097553&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001216%2Fabstract%3Frss%3Dyes Abstract: Few reports exist on venomous snake bites during pregnancy. Envenomation during pregnancy can result in fetal and maternal death. A woman at 33 weeks of gestation presented with green tree viper envenomation and vaginal bleeding. Investigation revealed a grossly deranged coagulation profile, severe anemia and a dead fetus. After correction of the coagulation profile, induction of labor was followed by vaginal delivery. Postpartum care was uneventful, and the patient was discharged five days post partum. Green tree viper bite may cause fetal demise before the onset of maternal symptoms. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097553 Mon, 30 Nov 2009 00:00:00 +0100 3097553 http://www.medworm.com/index.php?rid=3097552&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001174%2Fabstract%3Frss%3Dyes We report the successful use of general anaesthesia for caesarean section in a patient with this disease. Potential anaesthetic concerns include autonomic dysreflexia and hyperkalaemia following the use of suxamethonium. Further complicating issues with this patient included psychotic depression and new-onset neuropathic pain on a background of chronic pain symptoms. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097552 Mon, 30 Nov 2009 00:00:00 +0100 3097552 http://www.medworm.com/index.php?rid=3097549&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001253%2Fabstract%3Frss%3Dyes Abstract: A case of subarachnoid hematoma following spinal anesthesia for cesarean section in a patient with HELLP syndrome is reported. A 39-year-old woman underwent cesarean section under spinal anesthesia for worsening preeclampsia with HELLP syndrome. Despite full recovery from the spinal anesthetic, on the second postoperative day she felt numbness on the posterior aspect of her right leg, noticed she was insensitive to bladder fullness and had mild flaccid paraparesis. Magnetic resonance imaging revealed a spinal subarachnoid hematoma with cauda equina compression. With conservative management she made an almost complete recovery within three months. Serial magnetic resonance imaging showed spontaneous regression of the hematoma. The risk of spinal subarachnoid hematoma following obs... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097549 Mon, 30 Nov 2009 00:00:00 +0100 3097549 http://www.medworm.com/index.php?rid=3097547&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X0900140X%2Fabstract%3Frss%3Dyes Conclusions: Fetal oxygen saturation values are similar in the first and second stage of labor in the presence or absence of epidural labor analgesia. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097547 Mon, 30 Nov 2009 00:00:00 +0100 3097547 http://www.medworm.com/index.php?rid=3097546&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001356%2Fabstract%3Frss%3Dyes Conclusions: Propofol induced vasodilatation and inhibited the vasoconstrictive effects of BK and PGF2α, in the human placenta. These findings suggest that propofol may not reduce fetal placental blood flow. Since propofol reduced the vasoconstricting effect of KCl but not that of AngII, we propose that the vasodilatory effect of propofol in the human placenta involves inhibition of Ca2+ channels. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097546 Mon, 30 Nov 2009 00:00:00 +0100 3097546 http://www.medworm.com/index.php?rid=3097545&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001319%2Fabstract%3Frss%3Dyes Conclusion: Our results suggest that in terms of accuracy, the two sites are equally suitable for use during caesarean section under neuraxial anaesthesia. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097545 Mon, 30 Nov 2009 00:00:00 +0100 3097545 http://www.medworm.com/index.php?rid=3097544&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001290%2Fabstract%3Frss%3Dyes Conclusion: Compared to the Neurotip™, the Neuropen® did not result in a reduction of the variability in the differences in spinal block levels when assessed by 35 different pairs of anaesthetists. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097544 Mon, 30 Nov 2009 00:00:00 +0100 3097544 http://www.medworm.com/index.php?rid=3097543&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001198%2Fabstract%3Frss%3Dyes Conclusions: Administration of granisetron 3mg i.v. reduces the severity of pruritus and the use of rescue anti-pruritic medication, and improves satisfaction but does not reduce the overall incidence of pruritus in women who have received subarachnoid morphine 150μg compared to ondansetron 8mg i.v. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097543 Mon, 30 Nov 2009 00:00:00 +0100 3097543 http://www.medworm.com/index.php?rid=3097542&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001125%2Fabstract%3Frss%3Dyes Conclusion: This study suggests that activation of spinal ERK might be involved in acute visceral pain arising from the uterine cervix. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097542 Mon, 30 Nov 2009 00:00:00 +0100 3097542 http://www.medworm.com/index.php?rid=3097541&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001289%2Fabstract%3Frss%3Dyes Conclusions: Umbilical artery pH was similar whether ephedrine or phenylephrine was used to maintain maternal arterial pressure, which contrasts with studies of low-risk caesarean section. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097541 Mon, 30 Nov 2009 00:00:00 +0100 3097541 http://www.medworm.com/index.php?rid=3097540&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001277%2Fabstract%3Frss%3Dyes Conclusions: Serious epidural catheter-related infection in obstetric patients is rare, but our incidence of serious deep tissue infection was at the upper extreme of figures quoted in other studies. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097540 Mon, 30 Nov 2009 00:00:00 +0100 3097540 http://www.medworm.com/index.php?rid=3097539&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001162%2Fabstract%3Frss%3Dyes Abstract: Background: Childbirth is an important life event for which a positive experience is important to many women.Methods: As secondary outcomes from the randomised controlled Comparative Obstetric Mobile Epidural Trial, various aspects of satisfaction were assessed in women who had one of three types of regional analgesia (two of which were low-dose techniques and a high-dose control using 0.25% epidural bupivacaine) and a comparison group who did not have epidural analgesia, shortly after delivery and 12 months later.Results: The predominant finding was satisfaction with spontaneous vaginal delivery whatever the mode of analgesia. The overall immediate and long-term satisfaction was similar for all three neuraxial techniques. Satisfaction with the speed of pain relief and the amount... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097539 Mon, 30 Nov 2009 00:00:00 +0100 3097539 http://www.medworm.com/index.php?rid=3097534&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001836%2Fabstract%3Frss%3Dyes To keep pace with IJOA’s increasing popularity, 2010 sees significant modification to its editorial structure. Since its launch in 1991, IJOA has had two Co-Editors. With the numbers of submissions increasing four-fold, it has become difficult both to handle submissions promptly and to provide our readers with up-to-date information. Consequently, we are expanding the editorial structure, with one Editor-in-Chief, Robin Russell, working with three Associated Editors and an Editorial Board of international experts. This, combined with Elsevier’s electronic editorial system introduced in 2008, will, we hope, reduce editorial response times and expedite publication of accepted papers. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097534 Mon, 30 Nov 2009 00:00:00 +0100 3097534 http://www.medworm.com/index.php?rid=2836880&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001563%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836880 Mon, 28 Sep 2009 16:09:38 +0100 2836880 http://www.medworm.com/index.php?rid=2836847&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001538%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836847 Mon, 28 Sep 2009 16:09:29 +0100 2836847 http://www.medworm.com/index.php?rid=2836879&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000909%2Fabstract%3Frss%3Dyes This A5 format paperback has British and American editors, and features contributors from the USA, UK, Canada, Israel, and Australia. They represent the specialties of obstetrics, gynaecology, fetal medicine, social science, surgery, medicine, biochemistry, molecular biology, dietetics, and anaesthetics. The writing style is predominantly academic, with frequent references to named authors and in some chapters a heavy use of statistics. This renders the book primarily of interest to clinicians and scientists rather than to lay readers and non-academic midwives. Some bullet point lists and pictures would have perhaps increased the readability of the book, but the content is comprehensive and thorough. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836879 Sun, 06 Sep 2009 23:00:00 +0100 2836879 http://www.medworm.com/index.php?rid=2836875&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001095%2Fabstract%3Frss%3Dyes In reply We thank Drs Dudeja for their interest in our manuscript and the interesting and valid discussion made regarding compensated and decompensated disseminated intravascular coagulation (DIC). However, we must stress that DIC is primarily a clinical diagnosis, and whilst laboratory tests are undertaken to confirm clinical suspicion, no single test is sensitive or specific to definitively diagnose DIC. As DIC is a dynamic process, laboratory tests provide only a snapshot of a complex disease process. Hence a common and potentially fatal error in managing DIC is to correct abnormal laboratory results instead of treating the underlying pathology. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836875 Sun, 06 Sep 2009 23:00:00 +0100 2836875 http://www.medworm.com/index.php?rid=2836874&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000934%2Fabstract%3Frss%3Dyes It is with great interest that we read the letter by Sinha et al. regarding the postpartum rupture of a splenic artery aneurysm presenting as disseminated intravascular coagulation (DIC). However, we believe there are contradictory findings in this case that are insufficient to label it as DIC. DIC is a syndrome ranging in severity from subclinical compensated activation of hemostatic factors (non-overt DIC) to a decompensated coagulopathy (overt DIC). Compensated DIC is not clinically evident and the usual laboratory tests for DIC can be normal. At times there may be thrombocytopenia, normal or even elevated fibrinogen concentrations, and marginally positive D-dimer levels. APTT and PT may be shorter than normal. In this case, the patient had bleeding from multiple sites, a clinical pictu... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836874 Sun, 06 Sep 2009 23:00:00 +0100 2836874 http://www.medworm.com/index.php?rid=2836869&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000867%2Fabstract%3Frss%3Dyes Abstract: There have been several reports of resistance to local anaesthetic agents in women with Ehlers-Danlos syndrome, hypermobility type, also known as Ehlers-Danlos syndrome Type III. General anaesthesia with rapid sequence induction was performed for caesarean section due to prolonged second stage of labour, but intubation proved to be difficult. We propose that intubation difficulty probably arose from collapse of fibro-elastic tissues and adjoining C-shaped cartilages of the trachea with appropriately applied cricoid pressure. We found no other case reports of difficult intubation in patients with Ehlers-Danlos syndrome, hypermobility type. There are reports of cervical spine instability and temporomandibular joint dysfunction in patients with this syndrome suggesting a potential f... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836869 Sun, 06 Sep 2009 23:00:00 +0100 2836869 http://www.medworm.com/index.php?rid=2836867&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000892%2Fabstract%3Frss%3Dyes Abstract: A 37-year-old parturient underwent emergency cesarean delivery because of severe preeclampsia. After induction of general anesthesia, the oxygen saturation decreased. Volatile anesthetics were discontinued and examination of the anesthetic circuit and machine revealed a soda lime canister that was extremely hot. The patient was detached from the anesthetic machine and hand-ventilated with an external oxygen cylinder. The surgery was cancelled and the patient was extubated. Analysis of the cylinder connected to the anesthesia machine displayed 100% carbon dioxide. The patient developed progressive respiratory failure. Bronchoscopic examination revealed burn scars from the carina to the main bronchi. The patient died within four months of the incident. (Source: International Journa... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836867 Sun, 06 Sep 2009 23:00:00 +0100 2836867 http://www.medworm.com/index.php?rid=2836862&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001113%2Fabstract%3Frss%3Dyes Obesity is now common amongst pregnant women, and its strong association with operative delivery means that obese women are more likely to require anaesthesia than the non-obese. There is also no doubt that obesity increases the risks of anaesthesia and some patients present technical challenges that are best faced by senior clinicians. But the motion proposes this level of care is required for all women with a body mass index (BMI) above 40kg/m2. Is this really necessary? (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836862 Sun, 06 Sep 2009 23:00:00 +0100 2836862 http://www.medworm.com/index.php?rid=2836861&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001101%2Fabstract%3Frss%3Dyes According to the Scotsman newspaper on Wednesday 26th September 2007, Scotland is the second fattest nation in the world with first place going to the USA. One in four Scottish adults is classified as obese, therefore I feel I have the experience to talk about this subject. I am going to concentrate on the problems caused by obesity and the reasons why I think trainees need supervision. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836861 Sun, 06 Sep 2009 23:00:00 +0100 2836861 http://www.medworm.com/index.php?rid=2836858&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000910%2Fabstract%3Frss%3Dyes ConclusionSignificant variations in practice exist in the prevention and treatment of spinal-induced hypotension. Fluid preloading and the prophylaxis and treatment of hypotension with ephedrine continue to be common practices. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836858 Sun, 06 Sep 2009 23:00:00 +0100 2836858 http://www.medworm.com/index.php?rid=3097535&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000879%2Fabstract%3Frss%3Dyes Conclusion: Persistent pain is more common one year after a caesarean section than after vaginal birth. A history of previous pain and pain on the day after delivery correlated with persistent pain. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097535 Fri, 04 Sep 2009 00:00:00 +0100 3097535 http://www.medworm.com/index.php?rid=2836878&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001150%2Fabstract%3Frss%3Dyes We report the management of a parturient receiving pentosan undergoing spinal anesthesia for cesarean delivery. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836878 Thu, 03 Sep 2009 23:00:00 +0100 2836878 http://www.medworm.com/index.php?rid=2836877&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001204%2Fabstract%3Frss%3Dyes I read with interest the recent article by Kopic and colleagues, and the accompanying editorial by Howell, regarding outreach programmes to the developing world, and their impact on the safety of obstetric anaesthesia. The article describes how the use of regional anaesthesia and analgesia increased after a two-week training programme. I derived most interest from the editorial, which expanded on the perceived needs in these developing-world institutions. Suggestions were made as to how the developed world could assist in improving poor outcomes associated with pregnancy in these areas. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836877 Thu, 03 Sep 2009 23:00:00 +0100 2836877 http://www.medworm.com/index.php?rid=2836868&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001137%2Fabstract%3Frss%3Dyes We report the hemodynamic, respiratory and sedative effects of dexmedetomidine on a parturient and neonate when used for awake fiberoptic intubation before cesarean section. A 35-year-old, gravida 4 para 0 aborta 3, 41-kg parturient at 35 weeks of gestation with spinal muscular atrophy presented for cesarean section. Dexmedetomidine was administered intravenously, total dose 1.84μg/kg over 38 minutes, followed by fiberoptic endotracheal intubation. Dexmedetomidine was then discontinued and general anesthesia was induced. The baby was delivered 68 minutes after the dexmedetomidine infusion was discontinued at which time blood samples were obtained for measurement of dexmedetomidine. During administration of dexmedetomidine, maternal heart rate, blood pressure and oxygen saturation remained... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836868 Thu, 03 Sep 2009 23:00:00 +0100 2836868 http://www.medworm.com/index.php?rid=2836863&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000855%2Fabstract%3Frss%3Dyes Conclusions: Carefully titrated regional analgesia is usually well tolerated in patients undergoing vaginal or cesarean delivery even in the presence of severe aortic stenosis. Standard monitoring is usually adequate for vaginal delivery, but invasive monitoring may facilitate management in some patients. An arterial line allows close monitoring of systemic blood pressure. Facilities for close 24-48-h post-partum observation should be available. A multidisciplinary approach is needed. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836863 Thu, 03 Sep 2009 23:00:00 +0100 2836863 http://www.medworm.com/index.php?rid=2836860&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001186%2Fabstract%3Frss%3Dyes This article, which is the result of reviewing over 1400 scientific manuscripts to create the 2008 Ostheimer lecture, focuses on three key areas: recent advances in labor analgesia, post-cesarean delivery analgesia and novel developments surrounding the long- term outcomes of preeclampsia. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836860 Thu, 03 Sep 2009 23:00:00 +0100 2836860 http://www.medworm.com/index.php?rid=2836859&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000922%2Fabstract%3Frss%3Dyes This study compared anxiety in two groups of women undergoing elective cesarean delivery to ascertain if their partner’s presence during neuraxial anesthesia placement affected patients’ overall anxiety levels.Methods: Three hundred fifteen patient-partner dyads were randomized to two groups: group 1 partners were present in the operating room during neuraxial anesthesia placement while group 2 partners remained outside the operating room during placement. Before surgery, all patient-partner dyads completed a survey of demographics, anesthetic experiences and baseline anxiety. Anxiety levels were rated using a visual analogue scale (VAS) and the state portion of the Spielberger State-Trait Anxiety Inventory.Results: The mean change in anxiety as measured by VAS among patients whose par... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836859 Thu, 03 Sep 2009 23:00:00 +0100 2836859 http://www.medworm.com/index.php?rid=2836854&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000843%2Fabstract%3Frss%3Dyes Abstract: Background: Levobupivacaine has a greater safety margin for cardiotoxicity than bupivacaine; consequently it has been recommended as the agent of choice for extending low-dose epidural analgesia for emergency caesarean section. We wished to compare the onset of levobupivacaine with that of a 2% lidocaine/epinephrine/fentanyl mixture.Methods: In a prospective, single blind study, we compared the speed of onset and efficacy of 20 mL of plain 0.5% levobupivacaine with 2% lidocaine/epinephrine 100 μg/fentanyl 100 μg for extending a previous low-dose labour epidural for emergency caesarean section in 100 patients.Results: The median [interquartile range] onset time for block of the T7 dermatome to touch from the end of the top up for 2% lidocaine /epinephrine/fentanyl mixture and le... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836854 Thu, 03 Sep 2009 23:00:00 +0100 2836854 http://www.medworm.com/index.php?rid=2836852&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000788%2Fabstract%3Frss%3Dyes Conclusion: The regional guidelines issued by the Aurore network were only partially followed. More effective guideline dissemination and implementation is required to improve the prevention and management of confirmed haemorrhage. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836852 Thu, 03 Sep 2009 23:00:00 +0100 2836852 http://www.medworm.com/index.php?rid=2836848&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001149%2Fabstract%3Frss%3Dyes Blood is good; more is better. Or is it? In this edition of the International Journal of Obstetric Anesthesia, we see this concept questioned through two retrospective audits of transfusion practices in the care of the obstetric patient. These studies originate from two countries: the United States and the United Kingdom, and from two different models of healthcare: fee for service and nationalized. Despite these differences, the articles highlight troubling similarities between US and UK transfusion practices. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836848 Thu, 03 Sep 2009 23:00:00 +0100 2836848 http://www.medworm.com/index.php?rid=2836850&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09001265%2Fabstract%3Frss%3Dyes Conclusions: Overall there appeared to be a low threshold for red cell transfusion, with 31% of transfusions occurring despite a haemoglobin >7g/dL and in the absence of ongoing bleeding or symptoms of anaemia. Such transfusions are deemed inappropriate according to the Royal College of Obstetricians and Gynaecologists guidelines. The main recommendations are to implement an educational programme and guidelines in all obstetric units, reduce blood use and encourage documentation of appropriate consent. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836850 Wed, 02 Sep 2009 23:00:00 +0100 2836850 http://www.medworm.com/index.php?rid=2836876&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X0900082X%2Fabstract%3Frss%3Dyes After the introduction of Braun Perifix® One (B. Braun Medical Ltd., Melsungen, Germany) epidural catheter sets to the obstetric unit, it was noted that the black centimetre markings dissolved from the catheter on exposure to Opsite∗ spray film dressing (Smith & Nephew Medical Ltd., Hull, UK) used to fix it to the skin. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836876 Wed, 26 Aug 2009 23:00:00 +0100 2836876 http://www.medworm.com/index.php?rid=3097551&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000612%2Fabstract%3Frss%3Dyes We present a case of presumed amniotic fluid embolism in a 33-year-old parturient at 30 weeks of gestation, which occurred just before she was due to receive spinal anaesthesia for urgent caesarean section. While sitting, the woman suddenly lost consciousness, started having convulsions and finally suffered cardiorespiratory collapse. She was resuscitated and a live baby was delivered by emergency caesarean section. An echocardiogram performed postoperatively showed a large atrial septal defect and severe right ventricular dysfunction with moderate pulmonary hypertension. Paradoxical amniotic fluid embolism was diagnosed. After extubation she was aphasic and had a right hemiparesis. She made a good recovery and was discharged from hospital 24 days later, at which time she had a slight weak... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097551 Tue, 25 Aug 2009 00:00:00 +0100 3097551 http://www.medworm.com/index.php?rid=3097550&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000636%2Fabstract%3Frss%3Dyes We report a case of an asymptomatic spinal cord neoplasm detected during the placement of a 25-gauge Whitacre spinal needle for spinal anesthesia before elective cesarean delivery. Subarachnoid blood was repeatedly aspirated during otherwise uncomplicated induction of spinal anesthesia. Magnetic resonance imaging revealed a spinal cord ependymoma in the lumbar spine. Asymptomatic spinal cord neoplasms and ependymomas are reviewed. Central nervous system pathology should be considered in the presence of persistent subarachnoid blood. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097550 Tue, 25 Aug 2009 00:00:00 +0100 3097550 http://www.medworm.com/index.php?rid=3097537&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000624%2Fabstract%3Frss%3Dyes Conclusion: Oral oxycodone produced comparable postoperative pain relief to intrathecal morphine with a lower incidence of pruritus, but was associated with a lower satisfaction score. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097537 Tue, 25 Aug 2009 00:00:00 +0100 3097537 http://www.medworm.com/index.php?rid=2836873&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X0900079X%2Fabstract%3Frss%3Dyes We report a case of suboptimal spinal anaesthesia as a result of an undetected defect on the syringe used for injection. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836873 Mon, 24 Aug 2009 23:00:00 +0100 2836873 http://www.medworm.com/index.php?rid=2836872&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X0900065X%2Fabstract%3Frss%3Dyes The American Society of Anesthesiologists Task Force on Management of the Difficult Airway has made recommendations for an extubation strategy after difficult tracheal intubation, which include the use of an airway exchange catheter. We would like to report the successful use of a Fogarty catheter sheath to assist extubation. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836872 Mon, 24 Aug 2009 23:00:00 +0100 2836872 http://www.medworm.com/index.php?rid=2836870&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000648%2Fabstract%3Frss%3Dyes We report a 28-year-old primigravida with the onset of hemophagocytic syndrome and cyopenia at 23 weeks of gestation. A further exacerbation at 28 weeks of gestation brought on preterm labor. General anesthesia was provided successfully for cesarean delivery. The patient recovered completely after this episode. We suggest that early diagnosis, multi-disciplinary intervention, pre-operative correction of the hematological abnormalities, general anesthesia and close postoperative monitoring are necessary. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836870 Mon, 24 Aug 2009 23:00:00 +0100 2836870 http://www.medworm.com/index.php?rid=2836866&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000776%2Fabstract%3Frss%3Dyes We report the peripartum management of a 29-year-old primigravid patient with neurocardiogenic syncope, which had been diagnosed six years previously on tilt-table testing. General principles were applied to minimise the risk of precipitating syncopal episodes. She had an uneventful ventouse-assisted vaginal delivery under epidural anaesthesia in our obstetric high dependency unit. The optimum management of these patients has yet to be established. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836866 Mon, 24 Aug 2009 23:00:00 +0100 2836866 http://www.medworm.com/index.php?rid=2836864&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000806%2Fabstract%3Frss%3Dyes We report a case of a patient with congenital aortic stenosis previously repaired using the Ross procedure, who presented to our unit for urgent caesarean delivery. Management was complicated by moderate residual cardiac disease and the presence of a suprapubic femoro-femoral crossover graft. Following application of five-lead electrocardiogram and invasive blood pressure monitoring, anaesthesia was induced via combined spinal-epidural with epidural volume extension. A high transverse surgical approach avoided the course of the vascular graft, while further precautions included the immediate availability of vascular surgeons and cell salvage. Our anaesthetic technique was tailored to minimise disruption to cardiovascular function, and in particular to limit regurgitant flow across the pulm... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836864 Mon, 24 Aug 2009 23:00:00 +0100 2836864 http://www.medworm.com/index.php?rid=2836857&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000594%2Fabstract%3Frss%3Dyes Conclusion: In our hospital, the use of spinal anaesthesia was not associated with decreased intra-operative time efficiency compared to general anaesthesia for elective caesarean section. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836857 Mon, 24 Aug 2009 23:00:00 +0100 2836857 http://www.medworm.com/index.php?rid=2836853&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000430%2Fabstract%3Frss%3Dyes Abstract: Background: Improving the success of external cephalic version (ECV) for breech presentation may help avoid some cesarean deliveries. The results of randomized trials comparing the success of ECV with neuraxial analgesia compared to control are inconsistent. We hypothesized that combined spinal-epidural (CSE) analgesia would increase the success of ECV when compared with systemic opioid analgesia.Methods: Parturients with singleton breech presentation (n=96) were randomized to receive CSE analgesia with bupivacaine 2.5mg and fentanyl 15μg (CSE group) or intravenous fentanyl 50μg (SYS group) before ECV attempt. The primary outcome was ECV success.Results: The success rate of ECV was 47% with CSE and 31% in the SYS group (P=0.14). Subsequent vaginal delivery was 36% for CSE and 2... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836853 Sun, 16 Aug 2009 23:00:00 +0100 2836853 http://www.medworm.com/index.php?rid=3097538&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000491%2Fabstract%3Frss%3Dyes Conclusions: Phenylephrine 100 μg and ephedrine 6 mg had similar efficacy in the treatment of maternal hypotension during spinal anaesthesia for elective caesarean delivery. Neonates in group P had significantly higher umbilical arterial pH and base excess values than those in group E, which is consistent with other studies. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097538 Mon, 10 Aug 2009 00:00:00 +0100 3097538 http://www.medworm.com/index.php?rid=2836871&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000557%2Fabstract%3Frss%3Dyes We present two parturients with classical symptoms of low-pressure headache, who each received neuraxial labour analgesia without a documented dural puncture with a Tuohy needle. Both parturients were successfully managed using acupuncture rather than an epidural blood patch. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836871 Sun, 09 Aug 2009 23:00:00 +0100 2836871 http://www.medworm.com/index.php?rid=2836865&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000582%2Fabstract%3Frss%3Dyes We report the successful anaesthetic management of repair of an abdominal aortic aneurysm in a patient with Takayasu’s disease at 14 weeks’ gestation. Anaesthesia was managed with combined epidural and general anaesthesia. During the intraoperative period haemodynamic parameters were well maintained. There were no episodes of haemodynamic fluctuations, oxygen desaturation or metabolic acidosis. Aortic cross-clamp time was 105min, blood loss around 1200mL, and central venous pressure maintained between 8 and 10cm H2O. There were no sudden changes in cardiac parameters, base deficit or urine output before or after cross clamping. The patient later delivered a full term, normal fetus. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836865 Sun, 09 Aug 2009 23:00:00 +0100 2836865 http://www.medworm.com/index.php?rid=2836856&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000533%2Fabstract%3Frss%3Dyes Conclusion: Warming intravenous fluids mitigates the decrease in maternal temperature during elective caesarean section under combined spinal-epidural anaesthesia and improves thermal comfort, but does not affect shivering. Intravenous fluids should be warmed routinely in elective caesarean section, especially for cases of expected long duration, but the use of pre-warmed fluids is as efficient and cheaper than using a Hotline® fluid warmer. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836856 Sun, 09 Aug 2009 23:00:00 +0100 2836856 http://www.medworm.com/index.php?rid=2836851&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000442%2Fabstract%3Frss%3Dyes This study summarizes our experience in the anaesthetic management of HORCS.Methods: The files of all parturients undergoing HORCS between January 1995 and August 2007 were reviewed to determine surgical times, rates and causes of conversion from neuraxial to general anaesthesia and the need to supplement neuraxial anaesthesia with intravenous sedation.Results: Parturients (n=108) were 35±4.5 years old with a gestational age of 37.5±1.5 weeks, weighed 88±20kg and had undergone 6±1 caesarean sections. Eighty-six (80%) were elective. Initial anaesthetic techniques included spinal (n=80, 74%), epidural (n=9, 8%), combined spinal-epidural (n=6, 6%) and general anaesthesia (n=13, 12%). Surgery lasted 38±19min (median 34, range 9-120). Fourteen parturients (13%) underwent intraoperative man... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836851 Sun, 09 Aug 2009 23:00:00 +0100 2836851 http://www.medworm.com/index.php?rid=2836849&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000405%2Fabstract%3Frss%3Dyes Abstract: Background: The decision to use red blood cell transfusion and/or blood products (fresh frozen plasma, platelets, cryoprecipitate) to manage obstetric hemorrhage or treat postpartum anemia is often made empirically by physicians. We performed a retrospective study to review transfusion outcomes in pregnant and postpartum patients at a large obstetric center.Methods: A retrospective, observational study was performed of obstetric in-patients who received red blood cell transfusion and/or blood products over a one-year period. Data abstracted included transfusion data, pre-transfusion hemoglobin (Hb) and lowest recorded (nadir) Hb, and maternal and neonatal outcomes.Results: During the study period, 74 patients received transfusion therapy (1.4%). Pre-transfusion and nadir Hb value... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836849 Wed, 22 Jul 2009 23:00:00 +0100 2836849 http://www.medworm.com/index.php?rid=3097548&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000387%2Fabstract%3Frss%3Dyes We describe a patient who was admitted to our hospital with deep vein thrombosis at 18weeks of gestation and who developed heparin-induced thrombocytopenia during her antenatal care. Therapeutic anticoagulation was initially achieved with argatroban, then changed to fondaparinux. During early labor, fondaparinux was discontinued and intravenous argatroban was substituted. Argatroban was discontinued during transition to active labor. After return of a normal partial thromboplastin time, combined spinal-epidural analgesia was induced for routine completion of labor and vaginal delivery. We discuss the decisions made in the maintenance of this patient’s anticoagulation during the peripartum period as well as timing of her neuraxial labor analgesia. (Source: International Journal of Obstetr... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=3097548 Wed, 22 Jul 2009 00:00:00 +0100 3097548 http://www.medworm.com/index.php?rid=2836855&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X0900048X%2Fabstract%3Frss%3Dyes Conclusion: Essential airway equipment was readily available in the event of a difficult obstetric intubation, with the exception of a fiberoptic bronchoscope. Few units conduct difficult airway training. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2836855 Tue, 21 Jul 2009 23:00:00 +0100 2836855 http://www.medworm.com/index.php?rid=2485977&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000995%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485977 Thu, 25 Jun 2009 07:19:34 +0100 2485977 http://www.medworm.com/index.php?rid=2485949&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X0900096X%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485949 Thu, 25 Jun 2009 07:19:34 +0100 2485949 http://www.medworm.com/index.php?rid=2485976&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000600%2Fabstract%3Frss%3Dyes The advantages of using the newer Flextip epidural catheters (Arrow International, Reading PA; B. Braun, Melsungen AG, Germany) include reduced incidences of paresthesia and accidental subarachnoid and intravascular placements. However, during removal, the catheter occasionally becomes stretched. We would like to report another problem with the Flextip catheter which can confound the stretching issue and make judging catheter depth more difficult. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485976 Sun, 24 May 2009 23:00:00 +0100 2485976 http://www.medworm.com/index.php?rid=2485972&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000399%2Fabstract%3Frss%3Dyes We read with interest the case report by Rupasinghe et al. of a woman with a large arachnoid cyst who underwent elective caesarean section using epidural anaesthesia. We would like to report a similar case involving a primigravida with a large posterior fossa arachnoid cyst. In this case, however, the patient had raised intracranial pressure (ICP) and was awaiting neurosurgical intervention. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485972 Sun, 24 May 2009 23:00:00 +0100 2485972 http://www.medworm.com/index.php?rid=2485971&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X0900051X%2Fabstract%3Frss%3Dyes We would like to thank Dr Llau and Dr Gogarten for their insightful comments on our letter describing the use of labor epidural analgesia in a patient receiving fondaparinux. Dr Llau has correctly pointed out an important error in the letter with regards to the Sociedad Española de Anestesiología y Reanimación (SEDAR) Guidelines on Anticoagulant Drugs and Neuraxial Anesthesia. The SEDAR guidelines do not contraindicate the use of epidural anesthesia in patients receiving thromboprophylaxis with fondaparinux. We offer our sincere apologies for this error. The recommended time-frame between fondaparinux administration and neuraxial blockade or epidural catheter removal is at least 36h, and at least 12h between the time of epidural catheter removal and fondaparinux administration. (Source:... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485971 Sun, 24 May 2009 23:00:00 +0100 2485971 http://www.medworm.com/index.php?rid=2485970&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000521%2Fabstract%3Frss%3Dyes I read with interest the letter by Aiono-Le Tagaloa and Carvalho in which they describe the use of epidural analgesia in labor in a patient receiving fondaparinux. I would like to highlight some misconceptions presented in this article. Firstly, being responsible for the Spanish Guidelines on Anticoagulant Drugs and Neuraxial Anesthesia which is the official opinion of the Sociedad Española de Anestesiología y Reanimación (SEDAR), I would like to point out that the information given in Table I of the letter is incorrect. Spanish recommendations do not contraindicate the use of epidural anesthesia with an indwelling catheter in patients receiving thromboprophylaxis with fondaparinux. Our guidelines regarding fondaparinux and neuraxial anesthesia were first published in 2003, and confirme... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485970 Sun, 24 May 2009 23:00:00 +0100 2485970 http://www.medworm.com/index.php?rid=2485968&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000569%2Fabstract%3Frss%3Dyes We report on a case of a 35-year-old primigravida at 36 weeks of gestation who was admitted to our hospital because of headache and cognitive and visual disturbances. At 13 years of age the patient had had a ventriculoperitoneal shunt for hydrocephalus related to an aqueduct stenosis. A computerized tomography scan of the brain showed moderate ventricular dilatation likely resulting from a malfunctioning shunt. On the second day after admission her level of consciousness and neurologic condition suddenly worsened and a second brain scan showed further enlargement of the ventricular system. After multidisciplinary consultation, it was decided to proceed with urgent sequential shunt revision and cesarean delivery. Anesthetic considerations included the risk of difficult airway, rising intrac... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485968 Sun, 24 May 2009 23:00:00 +0100 2485968 http://www.medworm.com/index.php?rid=2485964&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000363%2Fabstract%3Frss%3Dyes Abstract: After a road traffic accident a pregnant patient at 34weeks of gestation developed ARDS following blunt chest trauma, for which she required mechanical ventilation. Twenty-four hours after the accident, ongoing severe hypoxaemia with atelectasis mainly in the dorsal parts of the lung led to the decision to manage the patient in the prone position. Prone positioning over 8h resulted in a persistent improvement of oxygenation, which allowed extubation the following day. At term, however, our patient was admitted with dyspnoea, chest pain, haemodynamic instability and fetal bradycardia, for which she required emergency caesarean section followed by thoracotomy for haemothorax, from which she eventually made a full recovery. We have demonstrated that prone positioning can be used saf... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485964 Sun, 24 May 2009 23:00:00 +0100 2485964 http://www.medworm.com/index.php?rid=2485960&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000818%2Fabstract%3Frss%3Dyes The proposition that drugs should not be used ‘off-label’ seems, at first glance, to be one that fits with the zeitgeist. We are all encouraged to practice evidence-based medicine. Our traditional clinical freedom is all too often shown to be an excuse for anecdote to trump scientific standards of proof, and guidelines, managed care and clinical pathways are being increasingly imposed, often for good reason and to good effect, to rein in our more maverick tendencies. Why then should we not restrict ourselves to using drugs for the indications and in the doses, routes of administration and formulations for which they have been licensed and, therefore one must assume, rigorously tested? (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485960 Sun, 24 May 2009 23:00:00 +0100 2485960 http://www.medworm.com/index.php?rid=2485959&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000831%2Fabstract%3Frss%3Dyes Let us start by recognising that, in daily practice, most clinicians do, from time to time, use licensed medicines in unlicensed indications. This doesn’t mean that the debate is a lost cause. Rather, I propose to limit the discussion to what I would label as “silly” or “non-evidenced” unlicensed use, specifically in relation to obstetrics. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485959 Sun, 24 May 2009 23:00:00 +0100 2485959 http://www.medworm.com/index.php?rid=2485958&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000429%2Fabstract%3Frss%3Dyes Abstract: Background: Traditionally anaesthetic drugs for obstetrics are prepared as a contingency and stored until they are required for emergency use or have expired. Expiry is based on presumed reduction in sterility and efficacy although evidence for this is inconsistent. Preparation in advance introduces the risk of error and potential for tampering by a third party. Discarding and re-preparing drugs daily represents significant wastage with associated cost implications. We predicted that practice of drug preparation would differ widely across the UK, so conducted a national survey.Method: A postal questionnaire was sent to lead consultant obstetric anaesthetists at each of the 223 consultant-led UK obstetric units enquiring about the preparation of anaesthetic drugs for obstetric eme... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485958 Sun, 24 May 2009 23:00:00 +0100 2485958 http://www.medworm.com/index.php?rid=2485955&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000351%2Fabstract%3Frss%3Dyes Abstract: Background: Sufentanil is often added to ropivacaine and levobupivacaine to provide epidural analgesia in labour. The aim of this study was to compare the analgesic potencies of epidural ropivacaine and levobupivacaine in combination with sufentanil 0.5μg/mL, using the minimum local analgesic concentration (MLAC) model with up-down sequential allocation.Methods: In this prospective study parturients with cervical dilation⩾3cm who requested epidural analgesia between 0800 and 1500 were enrolled. They were randomly allocated to receive 20mL of either ropivacaine (group R) or levobupivacaine (group L) both with sufentanil 0.5μg/mL. Thirty minutes after initial injection a continuous infusion was started and maintained until delivery. The numbers of additional doses of 0.2% ropiv... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485955 Sun, 24 May 2009 23:00:00 +0100 2485955 http://www.medworm.com/index.php?rid=2485951&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000417%2Fabstract%3Frss%3Dyes Intrapartum neuraxial blocks have contended with and overcome many detractors to become the modus operandi for safe and effective analgesia in labour. Much research has been invested to enhance safety, efficacy and individualization of neuraxial blocks for women at various stages of labour. As a result, their use has dramatically escalated in recent years. The literature has been inundated by the constant quest for better techniques and drug concoctions for the induction and maintenance of neuraxial analgesia. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485951 Sun, 24 May 2009 23:00:00 +0100 2485951 http://www.medworm.com/index.php?rid=2485969&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000508%2Fabstract%3Frss%3Dyes Aiono-Le Tagaloa and Carvalho describe a case in which epidural analgesia was given to a patient receiving fondaparinux for heparin-induced thrombocytopenia (HIT) without haemorrhagic complications. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485969 Thu, 21 May 2009 23:00:00 +0100 2485969 http://www.medworm.com/index.php?rid=2485975&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000570%2Fabstract%3Frss%3Dyes We report the fracture of a new spinal needle during spinal anaesthesia in a morbidly obese parturient presenting for emergency caesarean section. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485975 Tue, 19 May 2009 23:00:00 +0100 2485975 http://www.medworm.com/index.php?rid=2485961&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000144%2Fabstract%3Frss%3Dyes Conclusions: The survey results support CEMACH recommendations for a nationally agreed obstetric EWS. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485961 Tue, 19 May 2009 23:00:00 +0100 2485961 http://www.medworm.com/index.php?rid=2485974&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000120%2Fabstract%3Frss%3Dyes Von Hippel-Lindau disease (VHLD) is a rare autosomal-dominant condition characterised by haemangioblastomas in the brain, spinal cord and retina. It is known to be associated with renal cell carcinoma, pancreatic tumours and phaeochromocytoma. Recommendations for the management of pregnant patients with VHLD are limited and inconsistent. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485974 Sun, 17 May 2009 23:00:00 +0100 2485974 http://www.medworm.com/index.php?rid=2485973&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000119%2Fabstract%3Frss%3Dyes Preeclampsia is a leading cause of maternal mortality in Nigeria. A previous study from our centre, conducted between 1998 and 2002, demonstrated a case-fatality rate of 4.8% for women with preeclampsia undergoing caesarean section. As a result of our study we recommended a more multidisciplinary approach to management and increased use of spinal anaesthesia for caesarean section. We reviewed anaesthetic management in this high-risk group in the subsequent four-year period between July 2002 and June 2006. The hospital records of women with preeclampsia or eclampsia who underwent caesarean section at the University of Nigeria Teaching Hospital (UNTH) were reviewed together with the hospital records of their newborns. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485973 Sun, 17 May 2009 23:00:00 +0100 2485973 http://www.medworm.com/index.php?rid=2485967&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X0900034X%2Fabstract%3Frss%3Dyes Abstract: Succinyl-CoA transferase deficiency is a high-risk condition that pre-disposes the sufferer to severe and life-threatening ketoacidosis. An 18-year-old woman with succinyl-CoA transferase deficiency was admitted to the delivery suite for induction of labour at 38weeks of gestation. Her management included adequate calorie intake in order to avoid fatty acid metabolism and adequate hydration along with rigorous electrolyte balance and minimisation of physiological stress by the use of epidural analgesia. The needs of the woman’s condition had to be balanced against the desire to minimise gastric volume in case emergency obstetric intervention was required. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485967 Sun, 17 May 2009 23:00:00 +0100 2485967 http://www.medworm.com/index.php?rid=2485966&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000338%2Fabstract%3Frss%3Dyes We report on a 38-year-old multiparous woman who presented at 36weeks’ of gestation with spontaneous rupture of membranes for urgent cesarean delivery. Preoperative coagulation tests were normal except for prolonged platelet adhesion and aggregation tests. The cesarean delivery was performed under spinal anesthesia with hyperbaric bupivacaine, fentanyl and morphine sulfate. Desmopressin was administered immediately after delivery. No perioperative complications were observed. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485966 Sun, 17 May 2009 23:00:00 +0100 2485966 http://www.medworm.com/index.php?rid=2485965&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000156%2Fabstract%3Frss%3Dyes We present the anaesthetic management of a 29-year-old parturient with metastatic carcinoid tumour. Although our patient did not ultimately develop carcinoid syndrome during the peripartum period, it was important that we used a multidisciplinary team approach, with close monitoring of her antenatal progress, and planned epidural analgesia for labour and delivery. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485965 Sun, 17 May 2009 23:00:00 +0100 2485965 http://www.medworm.com/index.php?rid=2485957&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000326%2Fabstract%3Frss%3Dyes Abstract: Background: A prospective cohort study was performed in 800 parturients undergoing elective caesarean section under spinal anaesthesia from May 2005 to April 2006 in a large maternity hospital in Singapore, in order to determine the incidence of and risk factors for total and partial failure of spinal anaesthesia.Methods: A routine single-shot spinal technique using intrathecal 0.5% heavy bupivacaine 2.0mL (10mg) and morphine 100μg was administered with a 27-gauge Whitacre spinal needle via a 20-gauge introducer. Demographic, surgical and anaesthetic data were collected to determine risk factors for failure of spinal anaesthesia.Results: Incidence of total failure requiring conversion to general anaesthesia was 0.5% (4 cases) in which three cases had inadequate block (loss of se... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485957 Sun, 17 May 2009 23:00:00 +0100 2485957 http://www.medworm.com/index.php?rid=2485956&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000132%2Fabstract%3Frss%3Dyes Conclusions: Intrathecal block is similar in extent and duration whether given as a single-shot spinal or a combined spinal-epidural with or without epidural volume extension when performed for elective caesarean section using hyperbaric bupivacaine in the sitting position. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485956 Sun, 17 May 2009 23:00:00 +0100 2485956 http://www.medworm.com/index.php?rid=2485954&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000041%2Fabstract%3Frss%3Dyes Conclusions: Neuraxial anaesthesia was effective for caesarean deliveries in obese and non-obese, in elective and emergency cases. Maternal obesity is associated with increased difficulty in performing neuraxial anaesthesia, but not with increased failure rate. Our study found no differences between obese and non-obese parturients in rate of caesarean deliveries, co-morbidities, indications for delivery or anaesthesia complications. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485954 Sun, 17 May 2009 23:00:00 +0100 2485954 http://www.medworm.com/index.php?rid=2485953&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001891%2Fabstract%3Frss%3Dyes Conclusions: For obstetric patients in the sitting position, the meniscus test does not improve diagnostic accuracy of aspiration for detecting intravascular multiorifice epidural catheter placement. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485953 Sun, 17 May 2009 23:00:00 +0100 2485953 http://www.medworm.com/index.php?rid=2485952&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000090%2Fabstract%3Frss%3Dyes Conclusion: Epidural administration of neostigmine 500μg and clonidine 75μg, following the intrathecal injection of ropivacaine and sufentanil, prolongs analgesia and reduces hourly ropivacaine consumption. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485952 Sun, 17 May 2009 23:00:00 +0100 2485952 http://www.medworm.com/index.php?rid=2485950&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000107%2Fabstract%3Frss%3Dyes The practice of adding opioids to local anesthetic agents for epidural labor analgesia was initiated over 25 years ago and was rapidly shown to have a number of beneficial effects. In addition to reducing unwanted local anesthetic side effects, the combination of these agents leads to higher maternal satisfaction and less impact on mode of delivery. This practice has transformed the management, and popularized the use, of epidural analgesia for labor and delivery in many countries. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485950 Sun, 17 May 2009 23:00:00 +0100 2485950 http://www.medworm.com/index.php?rid=2354294&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000211%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354294 Wed, 01 Apr 2009 04:00:00 +0100 2354294 http://www.medworm.com/index.php?rid=2354293&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000375%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354293 Wed, 01 Apr 2009 04:00:00 +0100 2354293 http://www.medworm.com/index.php?rid=2354292&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000077%2Fabstract%3Frss%3Dyes In the above letter, the only author listed was L. S. Polley when there should have been three authors, as listed above. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354292 Wed, 01 Apr 2009 04:00:00 +0100 2354292 http://www.medworm.com/index.php?rid=2354291&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001763%2Fabstract%3Frss%3Dyes is a new member of the Oxford Handbooks series, which aims to help anaesthetic trainees working on the labour ward. It achieves this by providing relevant, practical information in a compact size. Four editors, all of whom are consultant anaesthetists, and almost 40 contributors have achieved a comprehensive text. This is a practical book providing easily accessible and concise information. The text is neatly divided by bullets, headings and boxes, with several diagrams and photographs to illustrate salient points. With so many contributors covering such a large topic, there is inevitably some overlap between chapters. One should not be deterred by this as it is unlikely to be noticed unless the book is read from cover to cover. Where overlap does exist there is a refreshing consensus of ... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354291 Wed, 01 Apr 2009 04:00:00 +0100 2354291 http://www.medworm.com/index.php?rid=2354290&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000065%2Fabstract%3Frss%3Dyes Although a lower dose of intrathecal local anaesthetic is possible with combined spinal-epidural (CSE) than with single-shot spinal anaesthesia, the optimum dose has yet to be established. In a recent study by Teoh et al. 3.75mg of hyperbaric bupivacaine was successfully used to provide anaesthesia for elective caesarean section. We would like to report a case where an even lower dose provided adequate anaesthesia. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354290 Wed, 01 Apr 2009 04:00:00 +0100 2354290 http://www.medworm.com/index.php?rid=2354289&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000053%2Fabstract%3Frss%3Dyes Epidural levobupivacaine is commonly used in many obstetric units across the United Kingdom for obstetric analgesia and anaesthesia. Levobupivacaine has been reported to have similar efficacy but an enhanced safety profile compared to bupivacaine. To date, the occurrence of hiccups after epidural injection has not been described in the obstetric anaesthesia literature. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354289 Wed, 01 Apr 2009 04:00:00 +0100 2354289 http://www.medworm.com/index.php?rid=2354288&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X0900003X%2Fabstract%3Frss%3Dyes We present a case of a woman who suffered an accidental dural puncture during attempted EBP and a novel approach in management. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354288 Wed, 01 Apr 2009 04:00:00 +0100 2354288 http://www.medworm.com/index.php?rid=2354287&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001866%2Fabstract%3Frss%3Dyes We recently observed a case of hypoglossal nerve palsy, trigeminal nerve palsy and Horner’s syndrome in a 34-year-old women following epidural block for labour and subsequent caesarean section. Although Horner’s syndrome and other cranial nerve palsies have been reported following epidural analgesia and have received wide coverage in the anaesthetic literature, hypoglossal nerve palsy, we believe, has not previously been reported. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354287 Wed, 01 Apr 2009 04:00:00 +0100 2354287 http://www.medworm.com/index.php?rid=2354286&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001805%2Fabstract%3Frss%3Dyes Readers can investigate Kantian theory for themselves if they wish to understand it. There are several comments that we would like to make about this letter. Dr Balestrieri points out, and it should be clearly understood, that his use of the deontological argument is dependant on the fetus being recognized as a person. Without that recognition the theory does not apply. A potential risk of the deontological argument as used by the author is, if you force the woman to have a cesarean section, you are treating her “merely as a means” or simply as a vessel for the benefit of the fetus without any respect for her as a person. This would be a breach of the author’s deontological ethical position. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354286 Wed, 01 Apr 2009 04:00:00 +0100 2354286 http://www.medworm.com/index.php?rid=2354285&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001799%2Fabstract%3Frss%3Dyes We read with interest the letter by Dr. Balestrieri, relating to a principle-based ethical theory for evaluating clinical conflicts. The letter refers to a case in which a parturient decided to refuse cesarean section despite the potential consequence that her fetus may die. The clinicians treating her acceded to her wishes. The commentary by Dr. Balestrieri discusses an alternative ethical basis for decision making, leading to the patient’s wishes being overridden. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354285 Wed, 01 Apr 2009 04:00:00 +0100 2354285 http://www.medworm.com/index.php?rid=2354284&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001829%2Fabstract%3Frss%3Dyes On reviewing past copies of the journal I read with great interest both the editorial by Sullivan and Douglas and the case report by Weiniger et al. Although this response is rather late in coming, the topic it addresses continues to be a significant and current concern. While I agree that we do in fact generally employ principle-based ethics in our profession, I would suggest that there are other ethical systems that may be superior in particular cases and should be recognized and used. One such alternate ethical system is known as “deontological” ethics, or duty-based ethics, derived from the ancient Greek “δεον”, , usually translated as “duty”. Modern deontological theories are derived from the writings of the 18th century German philosopher Immanuel Kant. His analysis o... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354284 Wed, 01 Apr 2009 04:00:00 +0100 2354284 http://www.medworm.com/index.php?rid=2354283&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001878%2Fabstract%3Frss%3Dyes We report the successful use of extracorporeal membranous oxygenation in a previously healthy parturient with fulminant peripartum cardiomyopathy. Native cardiac function recovered rapidly, with weaning from extracorporeal membranous oxygenation after only 68h. This case highlights the potential of this lifesaving treatment, in appropriately selected patients, where death seems inevitable. No major complications of extracorporeal membranous oxygenation occurred in this patient. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354283 Wed, 01 Apr 2009 04:00:00 +0100 2354283 http://www.medworm.com/index.php?rid=2354282&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001854%2Fabstract%3Frss%3Dyes We present a case of the successful use of neuraxial analgesia/anesthesia for labor and vaginal delivery in a symptomatic parturient afflicted with carcinoid syndrome, who received an intravenous infusion of octreotide throughout labor and vaginal delivery. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354282 Wed, 01 Apr 2009 04:00:00 +0100 2354282 http://www.medworm.com/index.php?rid=2354281&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001842%2Fabstract%3Frss%3Dyes We report the anaesthetic management for caesarean section of two such parturients. One patient, with significant pulmonary involvement, received neuraxial anaesthesia for caesarean delivery. The second patient had general anaesthesia because investigations could not rule out neurological involvement. We review and discuss the anaesthetic considerations for obstetric patients with hereditary haemorrhagic telangiectasia. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354281 Wed, 01 Apr 2009 04:00:00 +0100 2354281 http://www.medworm.com/index.php?rid=2354280&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001787%2Fabstract%3Frss%3Dyes We present the case of a pregnant woman at 36 weeks of gestation who underwent uncomplicated neuraxial anesthesia for cesarean delivery. When neuraxial anesthesia is contemplated in such patients, they should first receive careful neurologic and radiologic evaluation. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354280 Wed, 01 Apr 2009 04:00:00 +0100 2354280 http://www.medworm.com/index.php?rid=2354279&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001775%2Fabstract%3Frss%3Dyes We present the case of a 25-year-old woman who, within 24h of spontaneous vaginal delivery at 32 weeks of gestation, developed signs of systemic infection and multi-organ failure requiring admission to the intensive care unit. Recombinant human activated protein C and intravenous immunoglobulin were used; subsequently heparin-induced thrombocytopenia and pulmonary embolus also required treatment. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354279 Wed, 01 Apr 2009 04:00:00 +0100 2354279 http://www.medworm.com/index.php?rid=2354278&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001568%2Fabstract%3Frss%3Dyes We present a case of spontaneous intracranial hypotension with typical clinical and magnetic resonance imaging findings in a pregnant patient who was treated with an epidural blood patch. The blood patch, performed at 32 weeks of gestation, produced transient improvement in symptoms but failed to completely cure the headache, which worsened over the next few days. Symptoms resolved over the subsequent three weeks with conservative therapy. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354278 Wed, 01 Apr 2009 04:00:00 +0100 2354278 http://www.medworm.com/index.php?rid=2354277&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X0800188X%2Fabstract%3Frss%3Dyes Abstract: Pulmonary hypertension is defined by a mean pulmonary artery pressure of greater than 25 mmHg at rest or 30 mmHg with exercise. It can occur in association with a variety of medical conditions. The most serious elevation in pulmonary artery pressures are seen in a group of conditions that share the histological entity of plexogenic pulmonary arteriopathy. Pulmonary hypertension may be missed or diagnosed late in the course of the illness. It is associated with a poor prognosis. Pulmonary hypertension carries a significant risk to mother and child during pregnancy and pregnant women with pulmonary hypertension require careful monitoring within the framework of a multidisciplinary team. Specific targeted therapy for pulmonary hypertension may be required during pregnancy. Many agen... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354277 Wed, 01 Apr 2009 04:00:00 +0100 2354277 http://www.medworm.com/index.php?rid=2354276&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000028%2Fabstract%3Frss%3Dyes Conclusion: Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension after spinal anesthesia for cesarean delivery. Surgery need not be delayed to allow a predetermined pre-load to be administered before induction of spinal anesthesia. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354276 Wed, 01 Apr 2009 04:00:00 +0100 2354276 http://www.medworm.com/index.php?rid=2354275&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001817%2Fabstract%3Frss%3Dyes Conclusion: In this population-based study, spinal anaesthesia was associated with an increased risk of neonatal mortality in very preterm infants compared to general anaesthesia (and epidural anaesthesia), independently from gestational age and characteristics of the pregnancies, deliveries and neonates. Although this multivariate analysis does not prove a causal relationship, the results suggest it could exist, particularly if maternal haemodynamics are poorly controlled. With recent significant change in the conduct of spinal anaesthesia, further studies are needed to investigate potential harmful effects of anaesthesia on very preterm infants delivered by caesarean section. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354275 Wed, 01 Apr 2009 04:00:00 +0100 2354275 http://www.medworm.com/index.php?rid=2354274&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001593%2Fabstract%3Frss%3Dyes Conclusions: Compared to previous reports, the incidence of block failure and PDPH in this study was unacceptably high and therefore the risks of the technique appear to outweigh the advantages of continuous spinal anesthesia in obstetric practice. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354274 Wed, 01 Apr 2009 04:00:00 +0100 2354274 http://www.medworm.com/index.php?rid=2354273&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001581%2Fabstract%3Frss%3Dyes Conclusions: Incremental spinal catheter anaesthesia offers effective anaesthesia with excellent haemodynamic control. Post dural puncture headache is of concern, and whilst it may be addressed by product modification, it currently limits widespread use of the Braun Spinocath in obstetric practice. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354273 Wed, 01 Apr 2009 04:00:00 +0100 2354273 http://www.medworm.com/index.php?rid=2354272&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X0800157X%2Fabstract%3Frss%3Dyes Conclusion: The ED95 of phenylephrine, administered as intermittent boluses to prevent pre-delivery spinal-induced hypotension and/or nausea at elective cesarean delivery, is at least 122 μg (lower limit of the confidence interval). The safety of this dose warrants further studies. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354272 Wed, 01 Apr 2009 04:00:00 +0100 2354272 http://www.medworm.com/index.php?rid=2354271&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001556%2Fabstract%3Frss%3Dyes Abstract: Background: Epidural and parenteral opioid analgesia are two common methods of pain relief in labor that may influence the autonomic nervous system. However, these effects on laboring women have not yet been adequately studied. The aim of our study was to assess the effects of these two methods of analgesia on autonomic nervous system modulation of maternal heart rate variability in laboring women.Methods: A prospective observational study was conducted on 64 laboring women; 33 received epidural analgesia with bupivacaine and fentanyl and 31 intravenous meperidine and promethazine. Power spectral analysis and nonlinear methods were applied to digitized electrocardiograms performed before and after administration of analgesia, to assess maternal heart rate variability and autonomi... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354271 Wed, 01 Apr 2009 04:00:00 +0100 2354271 http://www.medworm.com/index.php?rid=2354270&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001362%2Fabstract%3Frss%3Dyes Conclusion: We have successfully introduced cell salvage to our unit in a relatively short period of time and have used it for the largest series of patients reported in the UK. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354270 Wed, 01 Apr 2009 04:00:00 +0100 2354270 http://www.medworm.com/index.php?rid=2354269&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001143%2Fabstract%3Frss%3Dyes Conclusion: This study does not provide any evidence for a protective effect of cricoid pressure as used in this context, in preventing regurgitation or death. Preoperative gastric emptying may be a more effective measure to prevent aspiration of gastric contents. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354269 Wed, 01 Apr 2009 04:00:00 +0100 2354269 http://www.medworm.com/index.php?rid=2354268&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000089%2Fabstract%3Frss%3Dyes In an article in this edition of the International Journal of Obstetric Anesthesia, Fenton and Reynolds analyse reports on nearly 5000 emergency caesarean sections performed under general anaesthesia in Malawi. Nearly 3000 had cricoid pressure applied on induction; 24 patients regurgitated stomach contents, eight of whom died. The incidence of regurgitation was lower, but not significantly so, among those who did not have cricoid pressure applied. These results cast some doubt on the effectiveness of cricoid pressure in preventing regurgitation of stomach contents. However, cricoid pressure was applied by untrained personnel and the study was not randomised, so it is likely that the higher-risk patients received cricoid pressure. Also, as the authors suggest, it is possible that the clinic... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354268 Wed, 01 Apr 2009 04:00:00 +0100 2354268 http://www.medworm.com/index.php?rid=2354267&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X09000181%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2354267 Wed, 01 Apr 2009 04:00:00 +0100 2354267 http://www.medworm.com/index.php?rid=2216866&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19233640%26dopt%3DAbstract Authors: Vanner R PMID: 19233640 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2216866 Thu, 19 Feb 2009 05:00:00 +0100 2216866 http://www.medworm.com/index.php?rid=2200753&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19223168%26dopt%3DAbstract CONCLUSION: Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension after spinal anesthesia for cesarean delivery. Surgery need not be delayed to allow a predetermined pre-load to be administered before induction of spinal anesthesia. PMID: 19223168 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2200753 Fri, 13 Feb 2009 05:00:00 +0100 2200753 http://www.medworm.com/index.php?rid=2200752&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19223169%26dopt%3DAbstract Authors: Madden BP Pulmonary hypertension is defined by a mean pulmonary artery pressure of greater than 25 mmHg at rest or 30 mmHg with exercise. It can occur in association with a variety of medical conditions. The most serious elevation in pulmonary artery pressures are seen in a group of conditions that share the histological entity of plexogenic pulmonary arteriopathy. Pulmonary hypertension may be missed or diagnosed late in the course of the illness. It is associated with a poor prognosis. Pulmonary hypertension carries a significant risk to mother and child during pregnancy and pregnant women with pulmonary hypertension require careful monitoring within the framework of a multidisciplinary team. Specific targeted therapy for pulmonary hypertension may be required during pregnan... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2200752 Fri, 13 Feb 2009 05:00:00 +0100 2200752 http://www.medworm.com/index.php?rid=2200751&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19223170%26dopt%3DAbstract Authors: Koertzen M, Plaat F PMID: 19223170 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2200751 Fri, 13 Feb 2009 05:00:00 +0100 2200751 http://www.medworm.com/index.php?rid=2200750&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19223171%26dopt%3DAbstract Authors: Newman MJ, Andrew MI, Cyna AM PMID: 19223171 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2200750 Fri, 13 Feb 2009 05:00:00 +0100 2200750 http://www.medworm.com/index.php?rid=2200749&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19223172%26dopt%3DAbstract Authors: Kanniah SK PMID: 19223172 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2200749 Fri, 13 Feb 2009 05:00:00 +0100 2200749 http://www.medworm.com/index.php?rid=2173198&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19200712%26dopt%3DAbstract We report the successful use of extracorporeal membranous oxygenation in a previously healthy parturient with fulminant peripartum cardiomyopathy. Native cardiac function recovered rapidly, with weaning from extracorporeal membranous oxygenation after only 68h. This case highlights the potential of this lifesaving treatment, in appropriately selected patients, where death seems inevitable. No major complications of extracorporeal membranous oxygenation occurred in this patient. PMID: 19200712 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2173198 Wed, 04 Feb 2009 05:00:00 +0100 2173198 http://www.medworm.com/index.php?rid=2173197&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19200713%26dopt%3DAbstract Authors: Rowley C, Onslow J, Weston A PMID: 19200713 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2173197 Wed, 04 Feb 2009 05:00:00 +0100 2173197 http://www.medworm.com/index.php?rid=2173196&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19200714%26dopt%3DAbstract We present a case of the successful use of neuraxial analgesia/anesthesia for labor and vaginal delivery in a symptomatic parturient afflicted with carcinoid syndrome, who received an intravenous infusion of octreotide throughout labor and vaginal delivery. PMID: 19200714 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2173196 Wed, 04 Feb 2009 05:00:00 +0100 2173196 http://www.medworm.com/index.php?rid=2167814&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19195872%26dopt%3DAbstract Authors: Sullivan WJ, Douglas MJ PMID: 19195872 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2167814 Tue, 03 Feb 2009 05:00:00 +0100 2167814 http://www.medworm.com/index.php?rid=2167813&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19195873%26dopt%3DAbstract CONCLUSION: In this population-based study, spinal anaesthesia was associated with an increased risk of neonatal mortality in very preterm infants compared to general anaesthesia (and epidural anaesthesia), independently from gestational age and characteristics of the pregnancies, deliveries and neonates. Although this multivariate analysis does not prove a causal relationship, the results suggest it could exist, particularly if maternal haemodynamics are poorly controlled. With recent significant change in the conduct of spinal anaesthesia, further studies are needed to investigate potential harmful effects of anaesthesia on very preterm infants delivered by caesarean section. PMID: 19195873 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2167813 Tue, 03 Feb 2009 05:00:00 +0100 2167813 http://www.medworm.com/index.php?rid=2167812&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19195874%26dopt%3DAbstract We present the case of a 25-year-old woman who, within 24h of spontaneous vaginal delivery at 32 weeks of gestation, developed signs of systemic infection and multi-organ failure requiring admission to the intensive care unit. Recombinant human activated protein C and intravenous immunoglobulin were used; subsequently heparin-induced thrombocytopenia and pulmonary embolus also required treatment. PMID: 19195874 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2167812 Tue, 03 Feb 2009 05:00:00 +0100 2167812 http://www.medworm.com/index.php?rid=2167811&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19195875%26dopt%3DAbstract We present the case of a pregnant woman at 36 weeks of gestation who underwent uncomplicated neuraxial anesthesia for cesarean delivery. When neuraxial anesthesia is contemplated in such patients, they should first receive careful neurologic and radiologic evaluation. PMID: 19195875 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2167811 Tue, 03 Feb 2009 05:00:00 +0100 2167811 http://www.medworm.com/index.php?rid=2167810&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19195876%26dopt%3DAbstract Authors: Balestrieri PJ PMID: 19195876 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2167810 Tue, 03 Feb 2009 05:00:00 +0100 2167810 http://www.medworm.com/index.php?rid=2167809&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19196505%26dopt%3DAbstract Authors: Weiniger CF, Sprung CL, Weissman C, Matot I, Elchalal U PMID: 19196505 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2167809 Mon, 02 Feb 2009 05:00:00 +0100 2167809 http://www.medworm.com/index.php?rid=2167808&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19196506%26dopt%3DAbstract We report the anaesthetic management for caesarean section of two such parturients. One patient, with significant pulmonary involvement, received neuraxial anaesthesia for caesarean delivery. The second patient had general anaesthesia because investigations could not rule out neurological involvement. We review and discuss the anaesthetic considerations for obstetric patients with hereditary haemorrhagic telangiectasia. PMID: 19196506 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2167808 Mon, 02 Feb 2009 05:00:00 +0100 2167808 http://www.medworm.com/index.php?rid=2167807&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19196507%26dopt%3DAbstract CONCLUSIONS: Compared to previous reports, the incidence of block failure and PDPH in this study was unacceptably high and therefore the risks of the technique appear to outweigh the advantages of continuous spinal anesthesia in obstetric practice. PMID: 19196507 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2167807 Mon, 02 Feb 2009 05:00:00 +0100 2167807 http://www.medworm.com/index.php?rid=2485962&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X0800160X%2Fabstract%3Frss%3Dyes Abstract: For parturients desiring labor analgesia who have contraindications to neuraxial techniques, intravenous opioid-based patient-controlled analgesia (IVPCA) offers a reasonable alternative, although incomplete analgesia and maternal and neonatal respiratory depression can occur. Dexmedetomidine, a highly selective α2 agonist with negligible placental transfer, may be a valuable adjunct to IVPCA by providing additional analgesia without the respiratory depression associated with increasing opioid usage. The successful use of a dexmedetomidine infusion as an adjunct to unsatisfactory fentanyl IVPCA is reported in a 31-year-old parturient with spina bifida occulta and a tethered spinal cord reaching L5-S1. Dexmedetomidine significantly improved the analgesic quality; increased sedati... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485962 Mon, 02 Feb 2009 00:00:00 +0100 2485962 http://www.medworm.com/index.php?rid=2160557&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19188060%26dopt%3DAbstract Authors: Palanisamy A, Klickovich RJ, Ramsay M, Ouyang DW, Tsen LC For parturients desiring labor analgesia who have contraindications to neuraxial techniques, intravenous opioid-based patient-controlled analgesia (IVPCA) offers a reasonable alternative, although incomplete analgesia and maternal and neonatal respiratory depression can occur. Dexmedetomidine, a highly selective alpha(2) agonist with negligible placental transfer, may be a valuable adjunct to IVPCA by providing additional analgesia without the respiratory depression associated with increasing opioid usage. The successful use of a dexmedetomidine infusion as an adjunct to unsatisfactory fentanyl IVPCA is reported in a 31-year-old parturient with spina bifida occulta and a tethered spinal cord reaching L5-S1. Dexmedetomid... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2160557 Sat, 31 Jan 2009 05:00:00 +0100 2160557 http://www.medworm.com/index.php?rid=2156711&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19181514%26dopt%3DAbstract CONCLUSIONS: Incremental spinal catheter anaesthesia offers effective anaesthesia with excellent haemodynamic control. Post dural puncture headache is of concern, and whilst it may be addressed by product modification, it currently limits widespread use of the Braun Spinocath in obstetric practice. PMID: 19181514 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2156711 Fri, 30 Jan 2009 05:00:00 +0100 2156711 http://www.medworm.com/index.php?rid=2485963&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X08001398%2Fabstract%3Frss%3Dyes Abstract: Primary pulmonary hypertension is a fatal disease that frequently becomes evident in pregnancy. The management of pregnant women with primary pulmonary hypertension poses a number of difficult problems, especially where regional anesthesia is considered to be contraindicated. A 30-year-old woman who developed primary pulmonary hypertension at 23 weeks of pregnancy was transferred to our hospital. Systolic pulmonary artery pressure and plasma brain natriuretic peptide levels were markedly elevated. Nitric oxide inhalation and prostacyclin prevented the progression of cardiac failure and reduced both plasma brain natriuretic peptide and pulmonary artery pressure. Cesarean section was performed at 32 weeks under general anesthesia. A combination of nitric oxide, prostacyclin, nitrog... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2485963 Wed, 21 Jan 2009 00:00:00 +0100 2485963 http://www.medworm.com/index.php?rid=2131434&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19162468%26dopt%3DAbstract CONCLUSION: The ED95 of phenylephrine, administered as intermittent boluses to prevent pre-delivery spinal-induced hypotension and/or nausea at elective cesarean delivery, is at least 122 mug (lower limit of the confidence interval). The safety of this dose warrants further studies. PMID: 19162468 [PubMed - as supplied by publisher] (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=2131434 Tue, 20 Jan 2009 05:00:00 +0100 2131434