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. Wed, 08 Feb 2012 07:39:18 +0100 http://www.medworm.com/index.php?rid=5580827&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001282%2Fabstract%3Frss%3Dyes This article covers several of the major themes that emerged from the 2010 literature. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580827 Sun, 01 Jan 2012 05:00:00 +0100 5580827 http://www.medworm.com/index.php?rid=5580817&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001312%2Fabstract%3Frss%3Dyes “If one looks out for faults it is only as a means of recognizing goodness”Confucius, Analects 4.8Following the infamous human experimentation abuses exposed at the Nuremberg trials, the later controversial exposure of the conduct of the Tuskegee study, and others since, there have been consistent efforts made by the medical community and regulatory bodies to ensure that all medical research is conducted in an ethical manner. Careful examination of the ethical principles of medical practice, and the medical profession’s relationship with society have informed decisions on how medical research should be practiced. One of the main objectives of this process has been to reassure individuals within society that they will not be unwittingly exposed to research that may potentially harm th... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580817 Sun, 01 Jan 2012 05:00:00 +0100 5580817 http://www.medworm.com/index.php?rid=5580816&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001294%2Fabstract%3Frss%3Dyes A Greek proverb says “When you go to bed with a clear head, you will not get up with a headache”. Not so for postdural puncture headache (PDPH): a consequence of a spinal, and a complication of an epidural, familiar to all obstetric anaesthetists. It frequently causes significant distress, especially since post-delivery it may restrict or even totally prevent a mother dealing with the challenging functional demands of a newborn child, sometimes while she is recovering from major surgery. Postdural puncture headache is induced by cerebrospinal fluid (CSF) loss and the consequences of low intracranial pressure and cerebral vasodilation when in the non-recumbent position. If it follows use of a small-gauge spinal needle, the intensity is usually mild to moderate and symptoms can often be ... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580816 Sun, 01 Jan 2012 05:00:00 +0100 5580816 http://www.medworm.com/index.php?rid=5580815&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001397%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580815 Sun, 01 Jan 2012 05:00:00 +0100 5580815 http://www.medworm.com/index.php?rid=5580826&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001269%2Fabstract%3Frss%3Dyes Abstract: Sepsis in pregnancy and the puerperium remains a significant cause of maternal mortality and morbidity worldwide. Major morbidity arising as a result of obstetric sepsis includes fetal demise, organ failure, chronic pelvic inflammatory disease, chronic pelvic pain, bilateral tubal occlusion and infertility. Early recognition and timely response are key to ensuring good outcome. This review examines the clinical problem of sepsis in obstetrics and the role of the anaesthetist in the management of this condition. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580826 Wed, 14 Dec 2011 05:00:00 +0100 5580826 http://www.medworm.com/index.php?rid=5580836&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001270%2Fabstract%3Frss%3Dyes The 2000–2002 Confidential Enquiry into Maternal and Child Health report stated “isolated obstetric units present major difficulties in terms of immediate availability of additional skilled anaesthetic back-up and assistance from other specialties, including critical care.” In October 2009 we conducted a survey of UK obstetric units, approved by the Obstetric Anaesthetists’ Association (OAA), to quantify the number of isolated obstetric units and the challenges they face. We defined a split-site maternity unit as one that was not within the main hospital building that houses the adult intensive care unit. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580836 Fri, 09 Dec 2011 05:00:00 +0100 5580836 http://www.medworm.com/index.php?rid=5580818&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001208%2Fabstract%3Frss%3Dyes Conclusions: Converting to spinal analgesia after accidental dural puncture did not reduce the incidence of headache or blood patch, but was associated with easier establishment of neuraxial analgesia for labour. The most significant factor increasing headache and blood patch rates was the use of a 16-gauge compared to an 18-gauge epidural needle. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580818 Fri, 09 Dec 2011 05:00:00 +0100 5580818 http://www.medworm.com/index.php?rid=5580825&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001245%2Fabstract%3Frss%3Dyes This study was conducted to reassess the characteristics of maternal sepsis that have been managed in a French intensive care unit.Methods: A retrospective study of 66 women admitted to an intensive care unit for sepsis from 1977–2008 was performed. Data on sources of infection, microbial agents and maternal and fetal outcomes were collected. Data from 1977–1992 and 1993–2008 were compared.Results: Over time, the rate of intensive care admission for maternal sepsis did not change (0.75 episodes per 1000 deliveries in 1977–1992 versus 0.72/1000 in 1993–2008, P=1.0). The percentage of septic abortions decreased from 14% to 0%, whereas that of antepartum infections increased from 50% to 79% (P (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580825 Thu, 08 Dec 2011 05:00:00 +0100 5580825 http://www.medworm.com/index.php?rid=5580833&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X1100121X%2Fabstract%3Frss%3Dyes We describe the perioperative management of an epileptic parturient who developed hyponatraemia due to carbamazepine therapy. Caesarean delivery was performed under combined spinal-epidural anaesthesia with a good outcome for both mother and neonate. The diagnostic and therapeutic approach, anaesthetic implications and maternal and neonatal risks for a patient with hyponatraemia complicating carbamazepine therapy are discussed. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580833 Wed, 07 Dec 2011 05:00:00 +0100 5580833 http://www.medworm.com/index.php?rid=5580824&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001178%2Fabstract%3Frss%3Dyes This study was conducted to investigate the onset of labor epidural analgesia using 0.17% ropivacaine with a varying dose of fentanyl. We hypothesized that the onset of analgesia would be shortened in proportion to an increase in fentanyl dose.Methods: Women requesting labor epidural analgesia were enrolled in this randomized controlled clinical trial. Each woman was randomly assigned to receive fentanyl 0, 50, 75, or 100μg with 0.17% ropivacaine 12mL. The onset and duration of analgesia, the incidence of side effects and patient satisfaction were measured.Results: Data from 102 women were analyzed. The onset of analgesia (mean±SD) was shortened with an increasing dose of fentanyl (14.3±5.4, 14.2±6.5, 12.1±5.1, and 8.7±3.8min with fentanyl 0, 50, 75, or 100μg, respectively, P=0.001)... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580824 Wed, 07 Dec 2011 05:00:00 +0100 5580824 http://www.medworm.com/index.php?rid=5580823&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001166%2Fabstract%3Frss%3Dyes Abstract: Background: A common polymorphism of the μ-opioid receptor gene (OPRM1, p.118A/G), which has been shown to effect the response to neuraxial opioids, occurs in 30% of Caucasian women. This double-blind up-down sequential allocation study was designed to examine the effect of p.118A/G on the ED50 of epidural sufentanil for labor analgesia.Methods: Nulliparous women were recruited at 35weeks of gestation (n=77) and genotyped for p.118A/G. Those subsequently requesting epidural labor analgesia were enrolled. Each woman received epidural sufentanil diluted with 0.9% saline to a volume of 5mL. The initial sufentanil dose was 21μg, with subsequent doses determined by the response of the previous patient (testing interval 1μg). Efficacy was accepted if the visual analogue score decrea... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580823 Wed, 07 Dec 2011 05:00:00 +0100 5580823 http://www.medworm.com/index.php?rid=5580832&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001129%2Fabstract%3Frss%3Dyes We report the management of labor and delivery in two parturients with known ornithine transcarbamylase deficiency. Both patients were maintained on arginine, citrulline and sodium phenylacetate therapy with restricted protein intake during pregnancy. Neuraxial techniques were used for pain relief in labor and anesthesia for operative delivery. A dextrose infusion provided caloric intake during labor and perioperatively. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580832 Tue, 06 Dec 2011 05:00:00 +0100 5580832 http://www.medworm.com/index.php?rid=5580828&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001117%2Fabstract%3Frss%3Dyes We present a case of acute type A aortic dissection in a previously well multiparous woman, treated successfully by aortic root repair immediately following caesarean section. The acute presentation of aortic dissection and diagnostic clues that may have expedited the diagnosis are discussed. A brief literature review is presented of the perioperative management of patients undergoing cardiothoracic surgery post-caesarean section and the modifications to standard techniques that are required. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580828 Tue, 06 Dec 2011 05:00:00 +0100 5580828 http://www.medworm.com/index.php?rid=5580835&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001105%2Fabstract%3Frss%3Dyes We thank Drs. Wright and Levy for their interest in our report. We agree that the explanation about the effects of atosiban was not completely clear in the reference provided. However, we disagree that the antidiuretic effect of atosiban reduces the risk of congestive heart failure, and in fact consider that the opposite is true. We would like to qualify our original statement; “because of its structure, atosiban has affinity for vasopressin receptors and inhibition of anti-diuretic effects may cause congestive heart failure and hypertension.” A possible explanation for this was given by Donders et al. who suggested that when the oxytocin receptor is activated, the subsequent intracellular cascade can lead to activation of an inhibitory protein, which is antagonistic and inhibits the a... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580835 Mon, 05 Dec 2011 05:00:00 +0100 5580835 http://www.medworm.com/index.php?rid=5580831&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001099%2Fabstract%3Frss%3Dyes Abstract: A 22-year-old primiparous woman with known glycogen storage disease type 3a presented to our hospital during her 12th week of pregnancy. Glycogen storage disease type 3 is a rare inherited disorder resulting from a deficiency of the glycogen debranching enzyme, causing the accumulation of abnormal short-chain glycogen in liver, blood cells, myocardium and striated muscle. Symptoms improve after puberty but the increased metabolism of pregnancy predisposes to hypoglycaemia, ketosis and lactic acidosis. Cardiomyopathy, distal weakness and peripheral neuropathy may present after the third decade. The patient was managed antenatally with regular cornflour feeds and was scheduled for elective caesarean delivery. She presented in early labour at 38weeks and delivered a healthy neonate ... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580831 Mon, 05 Dec 2011 05:00:00 +0100 5580831 http://www.medworm.com/index.php?rid=5580838&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001087%2Fabstract%3Frss%3Dyes A number of new techniques and technologies have been introduced to obstetric anaesthesia practice during the past decade. These include remifentanil patient-controlled intravenous analgesia (PCIA) for labour pain, transversus abdominis plane (TAP) blocks for post-caesarean analgesia, neuraxial ultrasound imaging for epidural insertion, brain function monitoring for depth of anaesthesia and limited transthoracic echocardiography (TTE) or minimally invasive cardiac output monitoring (COM) to assess and monitor cardiac function. One author (M.P.) conducted a pilot survey during sabbatical leave in 2010 while attending four tertiary referral obstetric units in four different countries: KK Women’s Hospital (Singapore), Chelsea and Westminster Hospital (London, UK), Stanford Medical Center (P... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580838 Fri, 02 Dec 2011 05:00:00 +0100 5580838 http://www.medworm.com/index.php?rid=5580840&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001300%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580840 Mon, 28 Nov 2011 05:00:00 +0100 5580840 http://www.medworm.com/index.php?rid=5580829&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001142%2Fabstract%3Frss%3Dyes Abstract: The management of massive haemorrhage with blood products is changing as evidence arrives from civilian and military trauma. Rapid early replacement of coagulation factors and platelets is now becoming central to improving outcome, usually given in higher ratios with respect to red cell units than previously recommended and using empiric transfusion based on clinical rather than laboratory parameters. The management of three cases of major obstetric haemorrhage based on these principles is presented. Packed red blood cells, fresh frozen plasma, platelets and cryoprecipitate were transfused in the ratios 5:2:2:1, 4.5:1:1:1 and 4.5:2:1:1. Each patient had acceptable full blood count and coagulation results after surgery and all made an uneventful recovery. These outcomes support th... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580829 Mon, 28 Nov 2011 05:00:00 +0100 5580829 http://www.medworm.com/index.php?rid=5580822&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001130%2Fabstract%3Frss%3Dyes Conclusion: When pregnant women are taken to the operating room, a clinically and statistically significant increase in salivary alpha-amylase was observed. Further studies are required to define its clinical usefulness. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580822 Mon, 28 Nov 2011 05:00:00 +0100 5580822 http://www.medworm.com/index.php?rid=5580819&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001154%2Fabstract%3Frss%3Dyes Conclusion: There was no difference in the degree of sensation at 20min between Group B and Group BF. The only significant differences between the two techniques were a higher incidence of nausea and decrease in maternal blood pressure in Group B. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580819 Mon, 28 Nov 2011 05:00:00 +0100 5580819 http://www.medworm.com/index.php?rid=5580839&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11001191%2Fabstract%3Frss%3Dyes Dr. Rajpal’s name is listed incorrectly, and therefore the authorship list should read as above. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580839 Mon, 21 Nov 2011 05:00:00 +0100 5580839 http://www.medworm.com/index.php?rid=5580837&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000926%2Fabstract%3Frss%3Dyes The latest Centre for Maternal and Child Enquiries (CMACE) report highlighted concerns with the ability of labour ward staff to cope with emergency admissions when staffing is at maximum capacity. We performed a retrospective study which strongly supports existing evidence that the increasing age of pregnant women is stretching maternity services yet further. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580837 Mon, 21 Nov 2011 05:00:00 +0100 5580837 http://www.medworm.com/index.php?rid=5580830&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000938%2Fabstract%3Frss%3Dyes Abstract: The vast majority of females affected by hemochromatosis are asymptomatic during childbearing years. We were able to provide effective obstetric anesthesia care to a 35-year-old woman with severe hemochromatosis. She had systolic heart failure with a left ventricular ejection fraction of 15%, severe pulmonary hypertension, mitral insufficiency, a history of ventricular tachycardia, cirrhosis, obstructive sleep apnea, gestational diabetes, and severe scoliosis. A multidisciplinary approach was used to stabilize her heart failure and prepare her for childbirth. An arterial line and epidural analgesic were placed before induction of labor. Vaginal delivery was accomplished with passive decent of the fetus and forceps assistance. We discuss hemochromatosis and its implications for th... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580830 Mon, 21 Nov 2011 05:00:00 +0100 5580830 http://www.medworm.com/index.php?rid=5580821&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X1100094X%2Fabstract%3Frss%3Dyes Conclusions: The study results suggest that intrathecal fentanyl may induce acute tolerance to intrathecal morphine. However, because there was no difference in postoperative analgesia requirement and the difference in pain scores was small, the clinical significance of this finding is uncertain. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580821 Mon, 21 Nov 2011 05:00:00 +0100 5580821 http://www.medworm.com/index.php?rid=5580820&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000914%2Fabstract%3Frss%3Dyes Conclusion: Ondansetron 4mg, given intravenously 5min before subarachnoid block reduced hypotension and vasopressor use in parturients undergoing elective caesarean section. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580820 Mon, 21 Nov 2011 05:00:00 +0100 5580820 http://www.medworm.com/index.php?rid=5323530&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000975%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323530 Sat, 01 Oct 2011 04:00:00 +0100 5323530 http://www.medworm.com/index.php?rid=5323552&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000872%2Fabstract%3Frss%3Dyes Thank you for giving me the opportunity to respond to this letter. I think the great value of case reports is that they provide an opportunity for practitioners to compare protocols and practices with their own experience. When we wrote our article, the addition of isoproterenol (isoprenaline) was discussed but as we, nor our cardiology colleagues, had personal experience in the use of it in pregnancy we felt it prudent to leave the drug out of our algorithm rather than recommend its use purely based on theory. I am delighted that a group has experience in its use and feels it should be added to our original algorithm. I am sure isoproterenol could be a valuable drug in an emergency, especially where external pacing is not available. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323552 Thu, 22 Sep 2011 04:00:00 +0100 5323552 http://www.medworm.com/index.php?rid=5323546&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000896%2Fabstract%3Frss%3Dyes Abstract: A 34-year-old multiparous woman with a breech presentation, intrauterine growth restriction and premature rupture of membranes was transferred to our referral unit at 33weeks of gestation. She was diagnosed with Alagille syndrome soon after birth because of cholestasis and pruritus. Her condition was later complicated by esophageal varices, treated with propranolol, thrombocytopenia, and insulin-dependent diabetes. She had characteristic facies, posterior embryotoxon, “butterfly” vertebrae but had no cardiac or renal abnormalities. Due to the early onset of spontaneous labor, emergency cesarean section under general anesthesia was performed 48h after admission. This is the first case describing anesthetic care during delivery in a patient with Alagille syndrome. We discuss th... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323546 Mon, 19 Sep 2011 04:00:00 +0100 5323546 http://www.medworm.com/index.php?rid=5323541&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000823%2Fabstract%3Frss%3Dyes Abstract: The measurement of cardiac output may be crucial in the management of the parturient with haemodynamic instability due to critical illness or cardiac disease. Invasive haemodynamic monitoring may not be desirable due to the potential risk of complications and issues with patient compliance. Minimally- and non-invasive techniques of cardiac output measurement include those based on ultrasonic technology and pulse contour waveform analysis. This review article provides a synopsis of the literature examining currently available minimally- and non-invasive techniques for maternal cardiac output monitoring and looks at their advantages and disadvantages with respect to the parturient. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323541 Mon, 19 Sep 2011 04:00:00 +0100 5323541 http://www.medworm.com/index.php?rid=5323536&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000768%2Fabstract%3Frss%3Dyes Conclusions: Neuraxial blockade improved the likelihood of success during external cephalic version, although the dosing regimen that provides optimal conditions for successful version is unclear. Anesthetic rather than analgesic doses of local anesthetics may improve success. The findings suggest that neuraxial blockade does not compromise maternal or fetal safety during external cephalic version. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323536 Mon, 19 Sep 2011 04:00:00 +0100 5323536 http://www.medworm.com/index.php?rid=5323544&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000884%2Fabstract%3Frss%3Dyes Abstract: The use of epidural blood patches has become standard treatment for postdural puncture headache. Two cases suggest that there may occasionally be incomplete resorption of the blood patch, resulting in scarring in the epidural space that can be visualised using postpartum contrast injection and fluoroscopy. Both patients had a previous caesarean delivery during which they had suffered inadvertent dural punctures followed by epidural blood patches. When subsequently presenting for repeat caesarean delivery, both had inadequate epidural anaesthesia. Epidural insertion was then repeated, resulting in successful anaesthesia in one patient but a total subdural block with delayed apnoea and unconsciousness in the other. Distortion of epidural anatomy by fibrosis was considered to be a p... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323544 Thu, 15 Sep 2011 04:00:00 +0100 5323544 http://www.medworm.com/index.php?rid=5323560&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000859%2Fabstract%3Frss%3Dyes Henoch–Schonlein purpura (HSP) is a small vessel vasculitis characterised by the deposition of IgA antibodies and immune complexes in blood vessels and renal mesangium. It affects children more commonly than adults, although it can occur at any age. The classic triad of HSP is that of purpura, arthritis and abdominal pain. HSP nephritis is a common complication which may lead to renal failure. There is also an associated risk of haemorrhagic complications involving lungs, brain, gastrointestinal tract and urinary system. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323560 Mon, 12 Sep 2011 04:00:00 +0100 5323560 http://www.medworm.com/index.php?rid=5323557&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000793%2Fabstract%3Frss%3Dyes We present the case of a patient with thrombocytopenia-absent-radius (TAR) syndrome who had an elective caesarean section (CS) under general anaesthesia in whom thromboelastography was used to guide management. In PSPD there is a decreased or absent secretion of platelet granules, whilst TAR is characterised by a quantitative reduction in platelet numbers. In both, primary hemostasis is deficient and can present with platelet-type bleeding manifestations. TAR is associated with cardiac and renal anomalies in addition to difficult intubation. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323557 Mon, 12 Sep 2011 04:00:00 +0100 5323557 http://www.medworm.com/index.php?rid=5323556&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000847%2Fabstract%3Frss%3Dyes Postpartum haemorrhage (PPH), most commonly caused by uterine atony, is a major cause of maternal mortality in developed countries. Each year, between 5 and 10 women die from PPH in the Czech Republic; 10 times as many survive life-threatening haemorrhage, but these women may suffer lifelong complications. Recombinant activated factor VII (rFVIIa; Novo-Seven®, Novo Nordisk, Begsvaerd, Denmark) has been frequently used ‘off-label’ to treat haemorrhage in patients without primary defects of the coagulation system, such as women with PPH. Guidelines for rFVIIa use in PPH have appeared in several countries, and clinical registry data supporting its use have been published from Northern Europe and Italy. The UniSeven registry was established in 2004 to collect data on rFVIIa administration... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323556 Mon, 12 Sep 2011 04:00:00 +0100 5323556 http://www.medworm.com/index.php?rid=5323555&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X1100077X%2Fabstract%3Frss%3Dyes Epidural catheter migration is a recognized problem during labor analgesia, with movement after insertion a cause of inadequate analgesia. The aim of our study was to compare the amount of catheter movement using the Epi-Guard fixation device (ED) with a standard dressing (SD). (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323555 Mon, 12 Sep 2011 04:00:00 +0100 5323555 http://www.medworm.com/index.php?rid=5323554&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000811%2Fabstract%3Frss%3Dyes Limited data exist regarding the incidence of chest infection and less serious morbidity following general anaesthesia for caesarean section (CS). The Obstetric Anaesthetists’ Association (OAA) leaflet providing information for mothers regarding anaesthesia for CS quotes the incidence of chest infection as 20%, sore throat as 20% and nausea and vomiting as 10%, although no supporting references are given. As these figures were not in keeping with our experience we decided to monitor their incidence over a calendar year. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323554 Mon, 12 Sep 2011 04:00:00 +0100 5323554 http://www.medworm.com/index.php?rid=5323553&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000835%2Fabstract%3Frss%3Dyes Preoxygenation is an essential part of obstetric general anaesthesia. In a recent study of preoxygenation, air entrainment occurred in 22% of patients, despite being performed in a calm environment with no clinical indication for urgency. In contrast, general anaesthesia for obstetric surgery is frequently performed in circumstances which require a degree of urgency and by personnel who may, on occasion, be less experienced. Consequently, we were concerned that the incidence of inadequate preoxygenation may be higher in clinical practice than seen in the more controlled conditions of a clinical trial. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323553 Mon, 12 Sep 2011 04:00:00 +0100 5323553 http://www.medworm.com/index.php?rid=5323548&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000781%2Fabstract%3Frss%3Dyes We thank Drs. Beavan and Clift for their comments. They suggest that passive-leg-rising (PLR) be used to evaluate fluid responsiveness in a spontaneous breathing patient as stroke volume variation (SVV) has only been fully validated in mechanically-ventilated patients. In the case described there were various problems: the patient refused blood transfusion and the issue was to balance fluid administration, oxygen delivery and consumption and hemodilution. As a result, in addition to SVV, we used cardiac index, stroke volume and the calculated oxygen delivery to guide our interventions. We looked at trends of these values rather than isolated numbers and believe this to be a useful approach. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323548 Mon, 12 Sep 2011 04:00:00 +0100 5323548 http://www.medworm.com/index.php?rid=5323545&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000860%2Fabstract%3Frss%3Dyes Abstract: Seven women received labor analgesia with 0.125% bupivacaine and fentanyl 2μg/mL delivered through a new generation of over-the-needle 23-gauge spinal catheters. The first patient was managed with intermittent bolus injections but inadequate pain control prompted a conversion to a continuous infusion for subsequent patients. One patient developed a postdural puncture headache following catheterization for 5h, but there were no headaches in those who had an indwelling catheter for 8h or longer. In one patient the catheter was also used to provide anesthesia for cesarean delivery with 0.5% bupivacaine and fentanyl 20μg. The largest drop in mean arterial blood pressure was 34% which occurred during the intermittent dosing period in the first patient. The mean blood pressure decrea... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323545 Mon, 12 Sep 2011 04:00:00 +0100 5323545 http://www.medworm.com/index.php?rid=5323532&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000902%2Fabstract%3Frss%3Dyes Morbidly adherent placenta or abnormal placentation comprises placenta accreta where placental villi adhere directly to the myometrium; placenta increta with invasion into the myometrium; and placenta percreta with invasion through the myometrium into the peritoneal cavity and possibly into other pelvic organs. Common to these conditions is failure of the placenta to separate normally after birth with accompanying uterine atony and ensuing major haemorrhage. There has been a 10-fold rise in the incidence of morbidly adherent placenta over the last four decades. Independent risk factors are the presence of a placenta praevia, previous caesarean section and advanced maternal age and as such it comes as no surprise that the incidence should be rising. Morbidly adherent placenta is associated ... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323532 Mon, 12 Sep 2011 04:00:00 +0100 5323532 http://www.medworm.com/index.php?rid=5323533&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000707%2Fabstract%3Frss%3Dyes Conclusion: In our case series in women with suspected placenta accreta, prophylactic use of uterine artery balloons was associated with a low requirement for blood transfusion but with possible increased risk of fetal compromise. Performing the interventional procedure at a different site from the operative room complicated management. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323533 Fri, 19 Aug 2011 04:00:00 +0100 5323533 http://www.medworm.com/index.php?rid=5323537&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000744%2Fabstract%3Frss%3Dyes Abstract: Background: Aortocaval compression is a major cause of maternal hypotension. A randomized controlled trial was designed to determine the effectiveness of a mechanical intervention using a right lumbar–pelvic wedge in preventing hypotension after spinal anesthesia for cesarean delivery.Methods: Eighty healthy women undergoing elective cesarean section were randomly allocated immediately after spinal blockade to either a lumbar–pelvic wedge positioned under the right posterior–superior iliac crest (Wedge group, n=40) or the complete supine position (Supine group, n=40). Hemodynamic values, vasopressor consumption and adverse effects were collected during the surgical procedure. Hypotension was defined as a reduction in systolic blood pressure of 25% from baseline. Patient all... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323537 Thu, 18 Aug 2011 04:00:00 +0100 5323537 http://www.medworm.com/index.php?rid=5580834&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000719%2Fabstract%3Frss%3Dyes We were interested in the report from Fernández, Domínguez and Delgado which described non-cardiogenic pulmonary oedema secondary to atosiban and steroids. We are, however, perplexed by the assertion that atosiban has an antidiuretic action. If that were the case, surely it would reduce the likelihood of congestive heart failure and hypertension, rather than increase the risk? Moreover, this point is not actually explored in the associated reference. Lastly, the authors stated that the woman had a Glasgow Coma Scale score of 12/15 in the operating room, ‘although she remained cooperative.’ From which of the three categories of ‘eyes’, ‘verbal’ and ‘motor’ was a 3-point deficit calculated? (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5580834 Tue, 16 Aug 2011 04:00:00 +0100 5580834 http://www.medworm.com/index.php?rid=5323559&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000732%2Fabstract%3Frss%3Dyes With increasing popularity of intrathecal drug delivery systems such as baclofen and opioids for management of chronic pain conditions, it is not uncommon for an obstetric anesthesiologist to encounter such a patient in the labor and delivery suite. A 44-year-old G1P0 female (177cm, 88kg) with left spastic hemiplegia and central post-stroke pain syndrome presented at the pre-anesthesia evaluation clinic to discuss her anesthesia options for labor and delivery. Past medical history included a middle cerebral artery infarct due to an embolus from a patent foramen ovale. An intrathecal baclofen pump (ITBP) was implanted to control the residual left-sided spasticity and neurological pain. An abdominal radiograph showed a subcutaneous infusion pump over the right lower abdominal quadrant with t... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323559 Tue, 16 Aug 2011 04:00:00 +0100 5323559 http://www.medworm.com/index.php?rid=5323558&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000689%2Fabstract%3Frss%3Dyes A 23-year-old woman at 38weeks of gestation required an urgent cesarean section because of arrest of dilatation and non-reassuring fetal heart tracings. She had a history of poorly-controlled asthma and had been using an albuterol inhaler up to four times daily, but denied any recent asthma attack. Preoperative physical examination was unremarkable. In the operating suite, crystalloid preloading was started and spinal anesthesia was administered at the L3–4 interspace with bupivacaine 12mg and morphine 200μg. The patient was positioned supine with 15° left lateral tilt. Standard monitors were applied, non-invasive blood pressure (BP) readings were taken at 1-min intervals and supplemental oxygen was administered via nasal cannulae. The BP fell to 75/39mmHg and after intravenous phenyle... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323558 Tue, 16 Aug 2011 04:00:00 +0100 5323558 http://www.medworm.com/index.php?rid=5323550&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000483%2Fabstract%3Frss%3Dyes Drs. Campbell and Yentis are to be congratulated on their keen eye and attention to the finest detail. We simply missed this classic example of the ‘Double R’ where the angle is calculated from the start of the run instead of the split point, resulting in an angle measurement that is lower than it should be. The dark line as is shown in their figure is the early calculation with the resultant angle ‘a’, whereas the appropriate angle is ‘b’ as is shown in their diagram. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323550 Tue, 16 Aug 2011 04:00:00 +0100 5323550 http://www.medworm.com/index.php?rid=5323543&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000690%2Fabstract%3Frss%3Dyes We report a case of a parturient with Laron syndrome, a rare form of dwarfism which results from an inability to generate insulin-like growth factor 1. In addition to dwarfism these patients may have craniofacial abnormalities, atlantoaxial instability, spinal stenosis and metabolic, musculoskeletal and genitourinary abnormalities. The patient underwent an urgent caesarean section using combined spinal-epidural anaesthesia. Laron syndrome is reviewed and its anaesthetic implications discussed. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323543 Tue, 16 Aug 2011 04:00:00 +0100 5323543 http://www.medworm.com/index.php?rid=5323542&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000677%2Fabstract%3Frss%3Dyes This report describes a primiparous woman requiring a category-1 emergency caesarean section for severe sepsis, in whom the cause of sepsis was found to be Plasmodium vivax malaria. A brief overview of malaria in pregnancy as relevant to this case and its outcome is presented. The report highlights the need for vigilance of all healthcare providers to allow timely recognition and management of rare but treatable disorders. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323542 Tue, 16 Aug 2011 04:00:00 +0100 5323542 http://www.medworm.com/index.php?rid=5323540&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000720%2Fabstract%3Frss%3Dyes Abstract: Care of pregnant migrants is a considerable challenge for all health care workers and health systems. Maternal mortality and serious morbidity are both greatly increased among migrants in western countries, particularly in Africans and asylum seekers. While in many instances, migrants are healthier than native populations and have better perinatal outcomes, this is inconsistent and poorer outcomes are described in many groups. The causes of suboptimal outcomes are numerous and are strongly influenced by the health-seeking behaviour of the parturients. Accordingly, improvement in outcome requires a multifaceted approach with a focus on early access to antenatal services and enhanced medical screening and surveillance for detection and optimisation of comorbid conditions. Provision... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323540 Tue, 16 Aug 2011 04:00:00 +0100 5323540 http://www.medworm.com/index.php?rid=5323538&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000665%2Fabstract%3Frss%3Dyes Abstract: Background: Labor epidural analgesia is associated with maternal hyperthermia. This pilot study compared the effects on maternal temperature during labor of different timing of initiation of the epidural component of combined spinal–epidural analgesia.Methods: After induction of analgesia with intrathecal bupivacaine 2mg and fentanyl 20μg, healthy term nulliparas in spontaneous labor were randomized to receive immediate epidural analgesia (n=26) or delayed epidural analgesia after the return of pain (n=28), by patient-controlled epidural analgesia with 0.125% bupivacaine and fentanyl 1μg/mL. Maternal tympanic temperature, visual analog scale pain score and dermatome block level were measured hourly during labor.Results: The duration of labor for most parturients (83.3%) was (... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323538 Tue, 16 Aug 2011 04:00:00 +0100 5323538 http://www.medworm.com/index.php?rid=5323534&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000653%2Fabstract%3Frss%3Dyes Conclusion: In this case series, the expectation of major blood loss at cesarean delivery in the presence of placenta accreta and attempts at uterine conservation surgery initially prompted a conservative approach using general anesthesia. Greater experience has permitted modification of this approach and neuraxial anesthesia is now employed more frequently. When managed appropriately, most patients are able to tolerate both prolonged surgery and significant blood loss under epidural anesthesia. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323534 Tue, 16 Aug 2011 04:00:00 +0100 5323534 http://www.medworm.com/index.php?rid=5323531&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000756%2Fabstract%3Frss%3Dyes The most recent UK Confidential Enquiry into Maternal Deaths reports a welcome decline in mortality as a result of major obstetric haemorrhage (MOH), it now being ranked the sixth most common cause of direct death. This improvement has in part resulted from better multidisciplinary care, better surgical techniques, use of interventional radiology and implementation of MOH protocols. Nevertheless the morbidity associated with MOH continues to be a significant problem. The Scottish Confidential Audit of Severe Maternal Morbidity Report of 2008 identified that MOH was responsible for approximately 80% of all morbidity occurring in Scottish mothers in the triennium 2006–2008 and MOH is the most common cause of obstetric-related intensive care admission. (Source: International Journal of Obst... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323531 Tue, 16 Aug 2011 04:00:00 +0100 5323531 http://www.medworm.com/index.php?rid=5323551&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000495%2Fabstract%3Frss%3Dyes We read with interest the algorithm suggested by Adekanye et al. for the management of bradyarrhythmias in pregnancy and labor. Recently, a 21-year-old (G2P1) parturient presented to our emergency department at 37weeks of gestation with thrombosed external hemorrhoids. Due to increasing pain and possibility of severe bleeding with vaginal delivery, she was admitted for hemorrhoidectomy. Her past medical history included congenital complete heart block (CCHB) diagnosed incidentally immediately postpartum following her first, uneventful pregnancy. The patient had remained asymptomatic and refused permanent pacemaker placement before her second pregnancy. Her electrocardiograms (ECGs) repeatedly demonstrated complete heart block and narrow complex junctional rhythm with rates in the low 40s t... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323551 Fri, 12 Aug 2011 04:00:00 +0100 5323551 http://www.medworm.com/index.php?rid=5323549&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000458%2Fabstract%3Frss%3Dyes We read with interest the case report by Rajpal et al. on the use of thromboelastography in the peripartum management of a patient with platelet storage pool disorder. We would like to bring the authors’ attention to a possible error in the graphical information displayed on the thromboelastogram (TEG) following administration of DDAVP (). The split point, seen when the tracing deviates from baseline representing initial clot formation, may not have been correctly identified. We believe the spilt point has been identified prematurely as an irregularity in the baseline can be seen at the point where the three lines drawn by the TEG software originate. As a consequence, an alpha angle of 25.4° was calculated whereas if the split point had been identified correctly, we estimate it would be... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323549 Fri, 12 Aug 2011 04:00:00 +0100 5323549 http://www.medworm.com/index.php?rid=5323547&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X1100046X%2Fabstract%3Frss%3Dyes We read with interest the report from Piraccini et al. and congratulate them on their management of severe postpartum haemorrhage in a Jehovah’s Witness patient. Their management of this difficult scenario was guided largely by the Flotrac/Vigileo cardiac output monitoring system (Edwards Lifesciences, Irvine, CA, USA). Specifically, optimization of preload was directed by stroke volume variation (SVV) which occurs due to changes in intrathoracic pressure during the respiratory cycle causing variation in caval blood flow with subsequent effects on preload. SVV has been validated as a predictor of fluid responsiveness in mechanically-ventilated patients in a number of studies. Generally, tidal volumes >8mL/kg and fixed respiratory rates are specified. The rationale for this is the need fo... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323547 Fri, 12 Aug 2011 04:00:00 +0100 5323547 http://www.medworm.com/index.php?rid=5323535&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000501%2Fabstract%3Frss%3Dyes Abstract: Background: Assessment of maternal coagulation to determine suitability for neuraxial anaesthesia and management of obstetric haemorrhage remains a challenge. Thromboelastography provides point of care patient assessment of the viscoelastic properties of whole blood clotting and can assist the clinician in haemostatic decision-making. The study aim was to determine the ROTEM® thromboelastometer 95% reference limits for third trimester parturients and to compare these with non-pregnant female controls.Methods: Following ethics committee approval and informed consent, citrated blood was sampled from 120 age-matched healthy pregnant and non-pregnant women. Thromboelastometry, using a ROTEM® point of care monitor, was performed with specific activators to measure the coagulation ti... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323535 Fri, 12 Aug 2011 04:00:00 +0100 5323535 http://www.medworm.com/index.php?rid=4960549&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000537%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960549 Thu, 23 Jun 2011 15:24:40 +0100 4960549 http://www.medworm.com/index.php?rid=4960551&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000471%2Fabstract%3Frss%3Dyes Mike Tunstall was easily the most important UK contributor to obstetric anaesthesia in the 20th century. His unassuming modesty gave no glimmer of this. He was a true original thinker and made a remarkable number of ground-breaking and life-saving advances in obstetric anaesthesia and neonatal resuscitation. The clarity of his thought is mirrored by clarity of expression in all his writing. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960551 Wed, 08 Jun 2011 23:00:00 +0100 4960551 http://www.medworm.com/index.php?rid=4960573&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000367%2Fabstract%3Frss%3Dyes Preeclampsia remains a leading cause of maternal morbidity and mortality in the UK, and fluid management in these patients may be difficult. Central venous pressure (CVP) monitoring has been recommended to guide fluid therapy in preeclampsia, but its value is uncertain. Serious complications caused by central venous catheter (CVC) insertion have been reported in women with preeclampsia. We surveyed obstetric anaesthetists in the UK about their use of CVP monitoring in preeclampsia. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960573 Sun, 05 Jun 2011 23:00:00 +0100 4960573 http://www.medworm.com/index.php?rid=4960572&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000070%2Fabstract%3Frss%3Dyes A parturient with a history of extremely difficult intravenous access recently presented to our unit. She had previously required two category-3 caesarean sections, at 29 and 32 weeks of gestation, respectively, for severe early-onset preeclampsia. On both occasions, despite multiple attempts at siting both peripheral and central access by different consultant anaesthetists, surgical cut-down procedures were required to provide venous access before surgery. She was therefore referred to our High Risk Obstetric Anaesthetic Clinic for assessment at 16 weeks of gestation in her third pregnancy. At that stage she had one palpable vein in her right antecubital fossa and visible scarring on her other limbs from previous cut-downs. Although venous access was considered possible in an elective sit... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960572 Sun, 05 Jun 2011 23:00:00 +0100 4960572 http://www.medworm.com/index.php?rid=4960570&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X1100029X%2Fabstract%3Frss%3Dyes The 3rd National Audit Project (NAP3) showed neuraxial blockade to have a very low rate of serious complications. However, persistent neurological deficit following such procedures is concerning for patients and professionals alike. We recently encountered a case of extremely prolonged weakness and sensory deficit, following intrathecal administration of hyperbaric bupivacaine and diamorphine, for elective caesarean section. The time to full recovery was approximately 48h. Imaging revealed no abnormalities. Although such a prolonged effect has been previously reported, it is highly unusual in our experience. We wanted to compare this incident with the experience of other obstetric anaesthetists. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960570 Sun, 05 Jun 2011 23:00:00 +0100 4960570 http://www.medworm.com/index.php?rid=4960569&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000252%2Fabstract%3Frss%3Dyes There has been much discussion about consent for labour epidurals and the appropriate amount of information women require. However, women’s capacity to give consent in labour attracts less attention. We investigated women’s views on their capacity to consent during labour with reference to the Mental Capacity Act (MCA) in England and Wales, specifically the statement that to give consent, a person must be able to: (1) understand the information relevant to the decision; (2) retain that information; (3) use or weigh that information as part of the decision making process; and (4) communicate that decision. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960569 Sun, 05 Jun 2011 23:00:00 +0100 4960569 http://www.medworm.com/index.php?rid=4960568&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000379%2Fabstract%3Frss%3Dyes There is evidence from studies of heart rate variability that relatively high levels of sympathetic activity before spinal anaesthesia are associated with lower minimum absolute values for systolic arterial pressure (SAP) during spinal anaesthesia for caesarean section. Two studies have also observed that a relatively high pre-spinal heart rate is associated with lower minimum values for SAP, expressed as a proportion of baseline, during spinal anaesthesia. A prophylactic vasopressor was not used in these studies. We have re-examined data from a previous study of women undergoing spinal anaesthesia for caesarean section, to assess whether differences in pre-spinal heart rate are associated with differences in the minimum value for SAP when a prophylactic vasopressor is given. (Source: Inte... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960568 Sun, 05 Jun 2011 23:00:00 +0100 4960568 http://www.medworm.com/index.php?rid=4960566&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000082%2Fabstract%3Frss%3Dyes I read with interest the results of a national survey regarding skin disinfection before spinal anaesthesia. However, the authors did not mention recommendations published in a recent letter to the British Journal of Anaesthesia. The potential neurotoxicity of more concentrated (>0.5%) chlorhexidine cleaning solutions was referred to by Bradbury et al. But in mentioning ChloraPrep® devices, no reference was made to the Summary of Product Characteristics (SmPC) of this solution. In its cautions, the SmPC state with ChloraPrep® Clear, contact with the meninges should be avoided, and with ChloraPrep® with Tint, direct contact with neural tissue must be avoided. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960566 Sun, 05 Jun 2011 23:00:00 +0100 4960566 http://www.medworm.com/index.php?rid=4960560&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000392%2Fabstract%3Frss%3Dyes Abstract: Hemophilia B is a rare X-linked disorder that may cause dramatic bleeding. Women account for only 3.2% of those clinically affected. The X-linked inheritance frequently delays the diagnosis in women and may expose the patient to an increased risk of adverse events. There is limited experience with these patients during labor and delivery. A 28-year-old primiparous woman with hemophilia B (bleeding phenotype) delivered a male infant by an unplanned cesarean delivery under general anesthesia following treatment with factor IX and normalization of her coagulation parameters, guided by thromboelastography. Postpartum vaginal bleeding required transfusion of two units of packed red blood cells. Factor IX supplementation continued for one week. Once diagnosed with hemophilia B, a multi... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960560 Sun, 05 Jun 2011 23:00:00 +0100 4960560 http://www.medworm.com/index.php?rid=4960558&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000409%2Fabstract%3Frss%3Dyes We present a review of five patients with suspected abnormal placentation who received SpHb monitoring during cesarean hysterectomy at our institution. We discuss the potential clinical utility of non-invasive hemoglobin monitoring for pregnant patients at high risk of obstetric hemorrhage, and the potential role of SpHb in guiding transfusion therapy. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960558 Sun, 05 Jun 2011 23:00:00 +0100 4960558 http://www.medworm.com/index.php?rid=4960557&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000240%2Fabstract%3Frss%3Dyes Conclusion: When compared to indomethacin 100mg, preoperative administration of tramadol 100mg provides superior postoperative analgesia with minimal adverse effects. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960557 Sun, 05 Jun 2011 23:00:00 +0100 4960557 http://www.medworm.com/index.php?rid=4960556&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000276%2Fabstract%3Frss%3Dyes Conclusion: Despite a low overall incidence of maternal and neonatal mortality, pregnancy in women with congenital heart disease was associated with significant maternal cardiac and neonatal complications. Elective cesarean delivery with neuraxial anesthesia was a common approach for high-risk parturients with congenital heart disease; however, the benefit of this mode of delivery and anesthetic technique could not be ascertained. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960556 Sun, 05 Jun 2011 23:00:00 +0100 4960556 http://www.medworm.com/index.php?rid=4960555&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000264%2Fabstract%3Frss%3Dyes Abstract: Background: The aim of this study was to determine serum oxytocin concentrations following different regimens of prophylactic oxytocin administration in women undergoing elective caesarean delivery.Methods: Thirty healthy pregnant patients were randomized, after clamping of the umbilical cord, to receive intravenous oxytocin in one of the following groups: G1 (n=9), 10IU of oxytocin infused over 30min (0.33IU/min); G2 (n=11), 10IU of oxytocin infused over 3min and 45s (2.67IU/min); and G3 (n=10), 80IU of oxytocin infused over 30min (2.67IU/min). Both patient and surgeon were blinded to allocation. Uterine tone was assessed by surgical palpation. Serum oxytocin concentration was determined by enzyme immunoassay before anaesthesia (T0) and at 5 (T5), 30 (T30) and 60 (T60) min after... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960555 Sun, 05 Jun 2011 23:00:00 +0100 4960555 http://www.medworm.com/index.php?rid=4960553&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000288%2Fabstract%3Frss%3Dyes Conclusion: Thromboelastography was able to detect and quantify the effect of unfractionated heparin on blood coagulability, an effect not detected by conventional laboratory tests. Thromboelastography demonstrated a pro-coagulant effect of surgery that was only partially mitigated by the use of unfractionated heparin. In this study, at a dose of 7500IU subcutaneous unfractionated heparin appears to have little anticoagulant effect. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960553 Sun, 05 Jun 2011 23:00:00 +0100 4960553 http://www.medworm.com/index.php?rid=4960552&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000434%2Fabstract%3Frss%3Dyes On 1st March 2011, the Centre for Maternal and Child Enquiries (CMACE) launched its eighth triennial review of maternal deaths in the UK. The confidential enquiry has been running for almost 60 years and has become recognised as the world’s finest medical audit. These enquiries have long been of interest to those of us practising obstetric anaesthesia. As a specialty we are implicated in deaths directly ascribed to anaesthesia and in those where our input, or lack thereof, was deemed to have had some bearing on outcome. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960552 Sun, 05 Jun 2011 23:00:00 +0100 4960552 http://www.medworm.com/index.php?rid=4960550&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000446%2Fabstract%3Frss%3Dyes This edition of the International Journal of Obstetric Anesthesia is accompanied by a supplement containing the best abstracts submitted to the 2011 Annual Scientific Meeting of the Obstetric Anaesthetists’ Association (OAA). This year 329 abstracts were submitted, a pleasing 33% increase from 2010, and with such large numbers to be marked, the assessment process was modified. Abstracts were divided into four groups: research, surveys, audits and case reports, with each category assessed by four experienced obstetric anaesthetists. Reassuringly, those abstracts scoring the highest marks came almost exclusively from the research category, endorsing the importance of new work. The 2011 supplement is, however, a little thinner than in previous years, containing only 100 abstracts considered... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960550 Sun, 05 Jun 2011 23:00:00 +0100 4960550 http://www.medworm.com/index.php?rid=4960571&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000069%2Fabstract%3Frss%3Dyes A healthy 31-year-old parturient was scheduled for elective caesarean section. Her history, physical examination and blood results were unremarkable. Spinal anesthesia using bupivacaine 10mg and sufentanil 2.5μg was performed with a 26-gauge Quincke needle in the sitting position using the midline approach at the L3–4 interspace. Surgery and recovery were uneventful, and the patient was discharged the following day in good health. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960571 Thu, 02 Jun 2011 23:00:00 +0100 4960571 http://www.medworm.com/index.php?rid=4960567&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000380%2Fabstract%3Frss%3Dyes We read with interest the review by professor Reynolds in which she expressed concerns about the opposition of some midwives to labour epidurals. Socio-economic status and race have been shown to affect the choice of analgesia in labour; in addition the beliefs and knowledge of midwives can be influential. Having observed differing epidural rates in two hospitals in our region of Yorkshire and the Humber (unit A 20% vs. unit B 42%), we conducted a survey of midwives in each unit. A total of 188 midwives were sent a questionnaire with replies received from 111 (59%; unit A 45/93 (48%), unit B 66/95 (70%)). (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960567 Thu, 02 Jun 2011 23:00:00 +0100 4960567 http://www.medworm.com/index.php?rid=4960565&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000057%2Fabstract%3Frss%3Dyes I read with interest the paper by Thon et al. describing the use of prophylactic internal iliac occlusion balloon catheters in parturients with placenta accreta. The pelvic collateral system is highly interconnected with aortic, internal iliac, external iliac and femoral components. Most abnormal placentation occurs in the lower uterine segment for which the main blood supply is by collaterals from the internal pudendal artery. The latter usually arise from the posterior division of the internal iliac artery, so occlusion of the anterior division of the internal iliac artery is unlikely to have a hemostatic effect in abnormal lower uterine abnormal placentation. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960565 Thu, 02 Jun 2011 23:00:00 +0100 4960565 http://www.medworm.com/index.php?rid=4960564&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000239%2Fabstract%3Frss%3Dyes We describe a case in which severe lower extremity radicular pain occurred after administration of 0.9% saline into the subarachnoid space through a catheter that had been left for 20h following inadvertent dural puncture in an obstetric patient. A 42-year-old (G8P7) woman was admitted for repeat cesarean delivery. Accidental dural puncture occurred during epidural placement. Following a slow 10-mL intrathecal injection of 0.9% normal saline an epidural catheter was advanced into the subarachnoid space. Spinal anesthesia was used for cesarean delivery and the subarachnoid catheter was kept in place for 20h. Before catheter removal, an additional 10mL of 0.9% saline was slowly administered into the intrathecal space. Almost instantly, the patient complained of back pain that progressed to l... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960564 Wed, 01 Jun 2011 23:00:00 +0100 4960564 http://www.medworm.com/index.php?rid=4960554&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000033%2Fabstract%3Frss%3Dyes Conclusions: Intrathecal bupivacaine was 1.14 times more potent for motor block in pregnant versus non-pregnant women. Our current data confirm the difference in local anesthetic requirement between non-pregnant and pregnant patients. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960554 Thu, 26 May 2011 23:00:00 +0100 4960554 http://www.medworm.com/index.php?rid=4960562&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10002025%2Fabstract%3Frss%3Dyes Abstract: Velocardiofacial or 22q11 deletion syndrome is a genetic condition caused by deletion 22q11, the deletion of a small segment of the long arm of chromosome 22. To our knowledge this is the first case report of a woman with Velocardiofacial syndrome presenting in late pregnancy for caesarean delivery. She had undergone a Tetralogy of Fallot repair as an infant and had residual pulmonary regurgitation. In addition examination revealed micrognathia and scoliosis. Neuraxial anaesthesia was unsuccessful and subsequent conversion to general anaesthesia was necessary despite concerns regarding her facial abnormalities, pulmonary regurgitation and mild intellectual impairment. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960562 Tue, 24 May 2011 23:00:00 +0100 4960562 http://www.medworm.com/index.php?rid=4658966&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000124%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658966 Thu, 31 Mar 2011 14:25:26 +0100 4658966 http://www.medworm.com/index.php?rid=4658972&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001962%2Fabstract%3Frss%3Dyes Abstract: Background: Postpartum haemorrhage is an important cause of maternal morbidity and mortality. It is associated with haemostatic impairment which may exacerbate bleeding.Methods: All deliveries over a 3-year period in a large UK unit were reviewed and cases of haemorrhage of 1500mL or more identified. Laboratory records were reviewed and the lowest value for haemoglobin, platelet count and fibrinogen, and longest value for prothrombin time and activated partial thromboplastin time within 24h of delivery were recorded.Results: Of 18501 deliveries there were 456 bleeds of 1500mL or more (2.5%). Fibrinogen levels correlated best with blood loss (r −0.48 P (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658972 Fri, 25 Mar 2011 00:00:00 +0100 4658972 http://www.medworm.com/index.php?rid=4658988&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001974%2Fabstract%3Frss%3Dyes Obstetric haemorrhage is one of the leading causes of maternal death and the major cause of morbidity. Substantial quantities of blood may be required during its management which, given the need for blood conservation, has led to recommendations by several bodies for the use of red cell salvage. Cell salvage in obstetrics has increased dramatically in the last decade. However, there is a lack of evidence for its use in terms of economic justification or transfusion reduction. Currently, there are also no criteria for setting up the cell saver machine because prediction of haemorrhage is difficult; this is important because initiating cell salvage when it is not needed is an obvious waste of resources. By identifying cases that are at high risk for significant haemorrhage, a rational approa... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658988 Thu, 17 Mar 2011 00:00:00 +0100 4658988 http://www.medworm.com/index.php?rid=4658973&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10002013%2Fabstract%3Frss%3Dyes Abstract: Background: Various interventions are used as prophylaxis for aspiration pneumonitis in obstetric anaesthesia. This review, based on a Cochrane systematic review currently being updated, examines whether interventions given before caesarean section reduce the risk of aspiration pneumonitis.Methods: Twenty-two studies, involving 2658 women providing data in a usable format for meta-analysis were identified.Results: Compared to no treatment or placebo, there was a significant reduction in the risk of intra-gastric pH (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658973 Mon, 14 Mar 2011 00:00:00 +0100 4658973 http://www.medworm.com/index.php?rid=4658971&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001986%2Fabstract%3Frss%3Dyes Conclusion: The combined absolute infant dose of pethidine and norpethidine received via milk was 1.8% of the neonatal therapeutic dose and the combined relative infant dose was below the 10% recommended safety level. Breastfed infants are at low risk of drug exposure when mothers self-administer epidural pethidine after caesarean delivery. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658971 Mon, 14 Mar 2011 00:00:00 +0100 4658971 http://www.medworm.com/index.php?rid=4658990&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000021%2Fabstract%3Frss%3Dyes A morbidly obese 37year old woman (weight 136kg, height 1.68m BMI 48kg/m2) experienced umbilical cord prolapse at 25weeks of gestation and was prepared for emergency caesarean delivery. Fetal compromise prompted an obstetric request for general anaesthesia, but anaesthetic assessment identified a Mallampati grade 4 airway with thick neck and prominent incisors in the presence of morbid obesity. Spinal anaesthesia was planned and senior anaesthetic assistance was summoned. Lumbar landmarks were impalpable and attempts at spinal anaesthesia were unsuccessful after 15min. The decision to proceed with general anaesthesia was made. A Pentax Airway Scope (AWS)® (Tokyo, Japan) videolaryngoscope was prepared before induction. The patient was positioned in a head-elevated ‘ramped’ position and... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658990 Thu, 10 Mar 2011 00:00:00 +0100 4658990 http://www.medworm.com/index.php?rid=4658989&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X11000045%2Fabstract%3Frss%3Dyes Pulmonary hypertension usually worsens during pregnancy and is associated with high maternal and neonatal mortality. We managed 30 parturients with pulmonary hypertension between 1998 and 2008 (). The majority were transferred from local clinics at near-term gestation. They did not have regular prenatal or cardiac consultation. After admission, all parturients were managed with absolute rest, supplementary oxygen and digoxin and furosemide as required. A multidisplinary team, including obstetricians, cardiologists, anesthesiologists and pediatricians made a plan for each parturient based on cardiac function, response to therapy and maturity and safety of the fetus. Although agents such as prostacyclin analogues, phosphodiesterase inhibitors and endothelin-receptor antagonists have been des... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658989 Thu, 10 Mar 2011 00:00:00 +0100 4658989 http://www.medworm.com/index.php?rid=4658980&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001895%2Fabstract%3Frss%3Dyes Abstract: A parturient with Fontan circulation required general anesthesia for urgent cesarean delivery and subsequent prolonged postoperative ventilation for newly-diagnosed pseudocholinesterase deficiency. Anesthetic management necessitated a thorough understanding of the hemodynamic principles of the Fontan circulation and physiologic adaptations during surgical delivery and recovery in the intensive care unit. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658980 Wed, 09 Mar 2011 00:00:00 +0100 4658980 http://www.medworm.com/index.php?rid=4658985&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001998%2Fabstract%3Frss%3Dyes We report a 21-year-old woman with Marfan’s syndrome who received successful labor epidural analgesia 10days after a lumbar epidural blood patch for spontaneous cerebrospinal fluid (CSF) leak. She had previously had one uncomplicated vaginal delivery and first presented to the High-Risk Obstetrics Clinic at 32weeks of gestation with a one-month history of worsening occipital headaches exacerbated by standing or sitting upright. Her symptoms were initially relieved by lying flat but had worsened to a state of constant pain and unrelieved nausea. She had a typical Marfanoid habitus. Neurological examination and routine laboratory tests were normal. Magnetic resonance imaging/magnetic resonance venography ruled out venous sinus thrombosis and the presumptive diagnosis was a spontaneous CSF ... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658985 Mon, 07 Mar 2011 00:00:00 +0100 4658985 http://www.medworm.com/index.php?rid=4658969&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001925%2Fabstract%3Frss%3Dyes Abstract: Background: The μ-opioid agonist remifentanil has a rapid onset and offset and a short half-life making it an attractive option for intravenous patient-controlled labour analgesia. We aimed to compare the efficacy of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour.Methods: Parturients were randomly assigned to receive intravenous patient-controlled analgesia with remifentanil (n=10) or epidural analgesia (n=10). Pain and satisfaction scores were assessed every hour by means of visual analogue scale, together with an observer sedation score. Side effects and neonatal outcome were noted.Results: After one hour, visual analogue pain scores had decreased significantly in both groups (remifentanil: −3.8±2.6, P (Source: Inter... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658969 Mon, 07 Mar 2011 00:00:00 +0100 4658969 http://www.medworm.com/index.php?rid=4658970&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001913%2Fabstract%3Frss%3Dyes Conclusions: For residents with no prior experience in obstetric anaesthesia, the most reliable factor in predicting difficult epidural cannulation was spinal abnormality. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658970 Mon, 14 Feb 2011 00:00:00 +0100 4658970 http://www.medworm.com/index.php?rid=4960563&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001949%2Fabstract%3Frss%3Dyes We report a 28-year-old primiparous woman at 41weeks of gestation with Sturge–Weber syndrome who developed unilateral weakness, aphasia, blurred vision and confusion. Preeclampsia was excluded. Neuroimaging showed left sided cerebral oedema and a right parieto–occipital lesion, most likely an angioma. Caesarean section was planned to avoid the risk of angioma rupture during labour. General anesthesia was avoided due to the haemodynamic response to laryngoscopy and reports of seizure-related mortality. Despite the possibility of raised intracranial pressure and precipitation of cerebral herniation, a lumbar epidural block was administered but failed. A subarachnoid block was successfully performed and a healthy infant delivered. The choice of anaesthesia was strongly influenced by detai... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960563 Fri, 11 Feb 2011 00:00:00 +0100 4960563 http://www.medworm.com/index.php?rid=4960561&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001858%2Fabstract%3Frss%3Dyes We report a case of starvation-induced metabolic ketoacidosis in a previously healthy 29-year-old, nulliparous woman at 32weeks of gestation. She was admitted to hospital with mild preeclampsia associated with persistent nausea and vomiting that progressed to severe preeclampsia requiring urgent control of hypertension before caesarean delivery. Prolonged and severe vomiting limited oral caloric intake and led to starvation ketoacidosis, characterised by ketonuria and a raised anion gap metabolic acidosis that required intensive care support. Despite significant metabolic derangement the patient appeared clinically well. Intravascular volume was replenished. Fluid restriction used as part of our preeclampsia treatment regimen delayed the therapeutic administration of sufficient dextrose, w... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960561 Fri, 11 Feb 2011 00:00:00 +0100 4960561 http://www.medworm.com/index.php?rid=4960559&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001937%2Fabstract%3Frss%3Dyes Abstract: Ankylosing spondylitis presents challenges for the obstetric anesthesiologist in administering neuraxial anesthesia or managing the airway. A pregnant patient with ankylosing spondylitis, cardiomyopathy and preeclampsia requiring cesarean delivery was managed with an awake nasotracheal fiberoptic intubation. The use of topical cocaine, epinephrine, phenylephrine, and oxymetazoline to produce nasal vasoconstriction is discussed. Selective alpha-2 agonists that can potentially provide nasal mucosa vasoconstriction and placental vasculature vasodilation are also discussed. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4960559 Fri, 11 Feb 2011 00:00:00 +0100 4960559 http://www.medworm.com/index.php?rid=4658987&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001950%2Fabstract%3Frss%3Dyes In reference to the case of interscapular pain submitted by McKeown and Watson, we were pleased to see this subject receive deserved attention in the medical literature. We were also interested to read their novel hypothesis (referred pain from the viscera due to fetal malpresentation) to explain this phenomenon. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658987 Fri, 11 Feb 2011 00:00:00 +0100 4658987 http://www.medworm.com/index.php?rid=4658975&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001901%2Fabstract%3Frss%3Dyes This article outlines the application of TTE in the specialty of obstetric anaesthesia and in the management of obstetric critical illness. It describes the importance of TTE education, quality assurance and outcome recording. It also discusses how barriers to the routine implementation of TTE in obstetric anaesthesia and management of obstetric critical illness can be overcome. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658975 Fri, 11 Feb 2011 00:00:00 +0100 4658975 http://www.medworm.com/index.php?rid=4658986&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001846%2Fabstract%3Frss%3Dyes Pain during uterine contractions is associated with periods of hyperventilation, which may cause a transient decrease in maternal arterial carbon dioxide tension and a subsequent period of hypoventilation and hypoxemia. Maternal hyperventilation may also have adverse effects on the fetus. Maternal alkalosis has been shown to cause a decrease in uterine blood flow, as well as a left shift in the oxygen–hemoglobin dissociation curve, with a resultant decrease in fetal oxygenation. Transcutaneous measurements of carbon dioxide and oxygen have been shown to correlate well with arterial blood gas values. Measurement of transcutaneous carbon dioxide (PtcCO2) has been identified as an important perioperative tool in cases where continuous and meticulous control of arterial CO2 levels is warrant... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658986 Thu, 10 Feb 2011 00:00:00 +0100 4658986 http://www.medworm.com/index.php?rid=4658974&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001810%2Fabstract%3Frss%3Dyes Abstract: The current article covers some of the major themes that emerged in 2009 in the fields of obstetric anesthesiology, obstetrics, and perinatology, with a special emphasis on the implications for the obstetric anesthesiologist. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658974 Thu, 10 Feb 2011 00:00:00 +0100 4658974 http://www.medworm.com/index.php?rid=4658967&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001883%2Fabstract%3Frss%3Dyes Morbidly adherent placenta, otherwise known as abnormal placentation, describes a spectrum of pathological conditions in which the placental villi adhere directly to (placenta accreta) or invade into (placenta increta) the myometrium, or invade through the myometrium to the serosa (placenta percreta). In the medical literature, the term “placenta accreta” has often been used loosely and incorrectly for all degrees of abnormal placentation. Because of the lack of intervening decidual tissue, these morbidly adherent placentae do not separate normally from the uterus after delivery which may lead to catastrophic postpartum haemorrhage. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658967 Thu, 10 Feb 2011 00:00:00 +0100 4658967 http://www.medworm.com/index.php?rid=4658968&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001652%2Fabstract%3Frss%3Dyes Conclusion: In this study acupressure wristbands applied bilaterally did not reduce the incidence of nausea and vomiting during labour and delivery. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658968 Mon, 03 Jan 2011 00:00:00 +0100 4658968 http://www.medworm.com/index.php?rid=4372947&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001640%2Fabstract%3Frss%3Dyes Conclusions: The haemodynamic effects of oxytocin in women with severe preeclampsia may be less predictable compared to findings in healthy pregnant women, suggesting that oxytocin should be given with caution in women with severe preeclampsia. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372947 Sat, 01 Jan 2011 00:00:00 +0100 4372947 http://www.medworm.com/index.php?rid=4372943&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001627%2Fabstract%3Frss%3Dyes Conclusions: We found no additional postoperative analgesic benefit of low-dose ketamine during cesarean delivery in patients who received intrathecal morphine and intravenous ketorolac. Subjects who received ketamine reported lower pain scores 2weeks postpartum. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372943 Sat, 01 Jan 2011 00:00:00 +0100 4372943 http://www.medworm.com/index.php?rid=4372941&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001706%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372941 Sat, 01 Jan 2011 00:00:00 +0100 4372941 http://www.medworm.com/index.php?rid=4658984&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001639%2Fabstract%3Frss%3Dyes We present the first report of inadvertent epidural infusion of acetaminophen. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658984 Thu, 23 Dec 2010 00:00:00 +0100 4658984 http://www.medworm.com/index.php?rid=4658979&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001664%2Fabstract%3Frss%3Dyes We report the anaesthetic management of a woman with Brugada syndrome for elective caesarean section of twins. There are few reports of this disease in pregnancy and we believe this is the first of elective caesarean section in a parturient with the syndrome. The characteristic electrocardiographic changes of the syndrome are linked to sodium channel blockers including local anaesthetics such as bupivacaine. The use of bupivacaine for intrathecal central neuraxial blockade as well as other drugs commonly used in obstetric anaesthesia is discussed. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658979 Thu, 23 Dec 2010 00:00:00 +0100 4658979 http://www.medworm.com/index.php?rid=4658978&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001676%2Fabstract%3Frss%3Dyes We describe the anaesthetic management of a patient with Liddle’s syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle’s syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle’s syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658978 Thu, 23 Dec 2010 00:00:00 +0100 4658978 http://www.medworm.com/index.php?rid=5323539&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001615%2Fabstract%3Frss%3Dyes Abstract: Despite widespread enthusiasm for using lumbar ultrasound in obstetrics, there are some who believe it is expensive and time-consuming, with undetermined risks and uncertain benefits. For decades, anesthesiologists have striven to perfect the identification and cannulation of the epidural space using skills learned during training and early clinical practice. These skills include knowledge of the relevant anatomy and detection of subtle tactile clues that aid successful placement of an epidural catheter. Indeed, obstetric anesthesiologists have managed to do this with great success without using imaging techniques. There is a long learning curve associated with lumbar ultrasound and it is unclear from the literature if the success rates associated with its use are superior to cli... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=5323539 Mon, 20 Dec 2010 05:00:00 +0100 5323539 http://www.medworm.com/index.php?rid=4658977&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001585%2Fabstract%3Frss%3Dyes We describe the peripartum management of a 26-year-old primigravida with a platelet storage pool disorder who underwent spontaneous vaginal delivery of twins with epidural analgesia. Postpartum hemorrhage from uterine atony, and cervical and vaginal lacerations were treated successfully with 1-desamino-8D-arginine vasopressin and blood products. The use of thromboelastography in the assessment and management of bleeding risk in the setting of platelet storage pool disorder is described. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658977 Mon, 20 Dec 2010 00:00:00 +0100 4658977 http://www.medworm.com/index.php?rid=4658976&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001573%2Fabstract%3Frss%3Dyes Abstract: Hepatopulmonary syndrome is characterised by hypoxaemia and intrapulmonary shunting in the presence of portal hypertension. It is uncommon in the obstetric population but may occur in patients with Budd–Chiari syndrome in the absence of severe liver dysfunction. We discuss the management of a primigravida with Budd–Chiari syndrome and persistent hepatopulmonary syndrome post liver transplantation. A literature review revealed only one report of a successful pregnancy in association with hepatopulmonary syndrome. We discuss its recognition in patients with liver disease and anaesthetic considerations in its presence. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658976 Mon, 20 Dec 2010 00:00:00 +0100 4658976 http://www.medworm.com/index.php?rid=4372954&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001561%2Fabstract%3Frss%3Dyes We describe an elective caesarean delivery in a patient with placenta percreta who underwent this technique. She developed bilateral pseudoaneurysms, unilateral arterial rupture and compromised vascular supply to her right leg secondary to thrombus formation, and suffered massive haemorrhage, both despite and as a result of intervention. This is the first case report of multiple complications in an obstetric patient after temporary internal iliac balloon occlusion in an elective setting. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372954 Mon, 20 Dec 2010 00:00:00 +0100 4372954 http://www.medworm.com/index.php?rid=4372950&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001287%2Fabstract%3Frss%3Dyes Abstract: When investigating different methods of maternal pain relief in labour, neonatal outcome has not always been at the forefront, or else maternal changes, such as haemodynamics, fever, length of labour, need for oxytocin or type of delivery, are taken as surrogates for neonatal outcome. It is essential to examine the actual baby and to appreciate that labour pain itself has adverse consequences for the baby. For systemic analgesia, pethidine has been most extensively studied and compared with neuraxial analgesia. It depresses fetal muscular activity, aortic blood flow, short-term heart rate variability and oxygen saturation. In the newborn it exacerbates acidosis, depresses Apgar scores, respiration, neurobehavioural score, muscle tone and suckling. Alternatives have few advantages... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372950 Mon, 13 Dec 2010 00:00:00 +0100 4372950 http://www.medworm.com/index.php?rid=4658982&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001469%2Fabstract%3Frss%3Dyes A healthy 24-year-old woman was referred to our neurosurgery department from another hospital seven days after delivery. An epidural catheter had been inserted for labor analgesia at what was presumed to be the L3–4 interspace. The catheter had been inserted too far and when attempting to withdraw it through the Tuohy needle, the catheter had broken. A second catheter had been inserted successfully for analgesia and after an uneventful delivery, the second catheter was removed without difficulty. The patient had been advised that a fragment of the first catheter remained in her back. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658982 Thu, 09 Dec 2010 00:00:00 +0100 4658982 http://www.medworm.com/index.php?rid=4658981&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001433%2Fabstract%3Frss%3Dyes A 33-year-old primigravida with a twin pregnancy at 30weeks of gestation was admitted with a diagnosis of premature labour. There was no evidence of infection, preeclampsia, hypertension, cardiovascular or pulmonary pathology. To accelerate fetal lung maturation, 12mg betamethasone was given by intramuscular injection and repeated 12h later. In addition, atosiban (Tractocyle® Ferring España S.A.U., Madrid, Spain) was initiated for tocolysis with an initial dose of 6.75mg followed by 300μg/min for 3h, and then 100μg/min. The dose was reduced to 50μg/min after 36h with the intention of suspending treatment in the following 12h. During the second night, the patient began to suffer nasal congestion and dyspnoea with accessory muscle use. Pulse oximetry showed oxygen desaturation and chest... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658981 Thu, 09 Dec 2010 00:00:00 +0100 4658981 http://www.medworm.com/index.php?rid=4372963&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001202%2Fabstract%3Frss%3Dyes I read with interest the report by McDonnell and colleagues detailing an episode of magnesium toxicity following inadvertent overdose during caesarean section. We have also experienced incidents that have led to revision of our policy for administration of magnesium. The processes by which this occurred demonstrate the value of incident reporting as part of an overall clinical risk management process. In our institution magnesium sulphate is presented as a 50% solution in a 50mL ampoule. It was administered in a 50-mL syringe via a syringe pump. The policy was to deliver a loading dose of 4g (8mL) via the pump and then decrease the infusion to a basal rate of 1–2g/h. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372963 Mon, 06 Dec 2010 00:00:00 +0100 4372963 http://www.medworm.com/index.php?rid=4372960&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001421%2Fabstract%3Frss%3Dyes We read with interest the article by Collier. The author postulates a new space for possible accidental distribution of local anaesthetic: the intradural space. However, referring to existing morphological literature and terminology, we have some concerns about Collier’s conclusions. Firstly, the Federative International Committee on Anatomical Terminology does not list an intradural space. “Terminologia anatomica” mentions a subarachnoidal, subdural and an epidural space. No regularly used anatomical textbook describes a space developed in the dura mater. Moreover, the textbook by Key and Retzius describes the different sheaths and spaces in great detail. This description, based on a series of injections on human and animal cadavers and living animals, includes histological investig... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372960 Mon, 06 Dec 2010 00:00:00 +0100 4372960 http://www.medworm.com/index.php?rid=4372958&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001445%2Fabstract%3Frss%3Dyes We present the case of a 38-year-old primiparous woman with type III Klippel–Feil syndrome for elective cesarean delivery. Our patient had a short webbed neck, short stature, limited neck flexion and extension, and thoraco-lumbar abnormalities. A multidisciplinary approach, involving obstetrics, medical subspecialties, anesthesiology, otolaryngology, and radiology, were utilized to evaluate and manage this patient. Pulmonary function testing revealed a restrictive defect, but transthoracic echocardiography was normal without pulmonary hypertension. We planned a combined spinal-epidural technique; however, only the epidural technique was obtained. Cesarean delivery was commenced with favorable maternal and fetal outcomes. Post-operative pain management was provided with intravenous morphi... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372958 Mon, 06 Dec 2010 00:00:00 +0100 4372958 http://www.medworm.com/index.php?rid=4372949&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X1000155X%2Fabstract%3Frss%3Dyes Conclusions: We conclude that the Portex connection system is more prone to disconnection and that connection design is an important consideration when trying to minimise catheter disconnection. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372949 Mon, 06 Dec 2010 00:00:00 +0100 4372949 http://www.medworm.com/index.php?rid=4372948&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001196%2Fabstract%3Frss%3Dyes Conclusion: Based on this comparative analysis of pregnant women who received high-doses of oxytocin, we found insufficient evidence to support that high-dose intravenous oxytocin elevates intrapartum maternal temperature. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372948 Fri, 03 Dec 2010 00:00:00 +0100 4372948 http://www.medworm.com/index.php?rid=4372970&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001603%2Fabstract%3Frss%3Dyes Obstetric high dependency care (OHDC) may reduce the need to transfer obstetric patients to a general critical care area, thereby allowing integrated care from midwives, obstetricians and anaesthetists while retaining the opportunity of early maternal-neonatal bonding. A questionnaire was sent to 228 obstetric units in the United Kingdom in September 2006 to quantify the availability and staffing for obstetric high-dependency care during the period 2005–06. The impact on intensive care unit (ICU) referral rates was also explored. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372970 Thu, 02 Dec 2010 00:00:00 +0100 4372970 http://www.medworm.com/index.php?rid=4372962&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001184%2Fabstract%3Frss%3Dyes We recently described the use of pulse contour analysis to observe the decrease in systemic vascular resistance (SVR) and increase in cardiac output (CO) associated with the use of hydralazine, labetalol and nicardipine to lower blood pressure in a patient with severe preeclampsia and chronic renal failure. We now report the use of electrical velocimetry to observe similar changes following drug administration in two other preeclamptic patients. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372962 Thu, 02 Dec 2010 00:00:00 +0100 4372962 http://www.medworm.com/index.php?rid=4372942&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001597%2Fabstract%3Frss%3Dyes On the morning of January 23, in the year 1883, the sun, shining through a thin veil of haze, tinted with a pale, orange light the snowbanks at the upper end of McLean Street. The long, grey faint shadow of the corner lamppost, stretching unevenly across the rutted roadway, slowly shortened with the advancing day and swung imperceptibly toward the hospital like a monitory finger. A wet salt chill was in the air, borne in from the sea upon a sluggish southeast wind. Men passing in the street felt its cold dampness through their greatcoats, and women wrapped themselves more tightly in their shawls as they hurried back to their firesides. Creeping through the cracks above the windows it stole into the wards, a harbinger of evil to the parents who shivered beneath their blankets.That afternoon... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372942 Thu, 02 Dec 2010 00:00:00 +0100 4372942 http://www.medworm.com/index.php?rid=4372961&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001536%2Fabstract%3Frss%3Dyes I thank Feigl et al. for their informed response to the paper on the ‘intradural’ space, as the fourth space which might be entered accidentally during epidural block. Having undertaken almost 200 epidural contrast injections and fluoroscopy following atypical epidural blocks, mostly in parturients, we have been able to differentiate a group whose clinical and radiographic findings were entirely different from those following either epidural, subdural or subarachnoid blocks. When we reported our initial findings in four patients in 2004, we were unsure as to how to categorise them, so they were described simply as cases of ‘atypical subdural block’. This was to differentiate them from cases of the well-recognised, classical or primary subdural block, but this terminology was rather... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372961 Wed, 01 Dec 2010 00:00:00 +0100 4372961 http://www.medworm.com/index.php?rid=4372946&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001548%2Fabstract%3Frss%3Dyes Abstract: Background: Pregnancy is associated with alteration in sleep patterns and quality. We wished to investigate whether pregnant women have a higher likelihood of a positive Berlin Questionnaire than non-pregnant women.Methods: Pregnant women ages 18–45 years (n=4074) presenting for delivery, and non-pregnant women ages 18–45 years (n=490) presenting for outpatient surgery provided demographic information and completed the Berlin Questionnaire evaluating self-reported snoring and daytime sleepiness. For the pregnant patients, the infant’s birth weight and Apgar scores were also recorded.Results: Of the 1439 patients with a positive Berlin Questionnaire, 96 were in the non-pregnant control population versus 1343 in the pregnant population (20% vs. 33%, respectively, P (Source: I... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372946 Wed, 01 Dec 2010 00:00:00 +0100 4372946 http://www.medworm.com/index.php?rid=4658983&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001482%2Fabstract%3Frss%3Dyes The number of critical incidents as a result of poor handovers in obstetric anaesthesia is of concern and can be reduced. A national survey showed that 94% of handovers were purely verbal and several critical incidents were reported as a result of their inadequacy. These incidents included delays in performing emergency caesarean sections, recognising acute renal failure and diagnosing spinal catheters. In our unit we have noted that unstructured verbal handovers have led, on occasion, to omission of vital information about patients with conditions such as placenta praevia and sepsis. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4658983 Mon, 29 Nov 2010 00:00:00 +0100 4658983 http://www.medworm.com/index.php?rid=4372973&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001299%2Fabstract%3Frss%3Dyes Women undergoing caesarean section are worried about intra- and postoperative pain. Good analgesia with minimal side effects is desirable if early mobility, bonding with the infant and prevention of chronic pain are to be achieved. There has been recent interest in the transversus abdominis plane (TAP) block for postoperative analgesia after caesarean section (CS), and ultrasound guidance has been investigated to provide reliable placement when performing TAP blocks for CS. There is no agreement about the optimal technique for performing TAP blocks, and both landmark and ultrasound-guided methods continue to be evaluated. We conducted a survey amongst UK-based obstetric anaesthetists to investigate the use and techniques of TAP blocks for post CS analgesia. (Source: International Journal o... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372973 Mon, 29 Nov 2010 00:00:00 +0100 4372973 http://www.medworm.com/index.php?rid=4372957&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001317%2Fabstract%3Frss%3Dyes We report the management of a 24-year-old primigravid woman who was diagnosed with myasthenia gravis at 20weeks of gestation. Maternal symptoms improved with therapeutic plasma exchange, steroids, immunoglobulin therapy and pyridostigmine. Despite this, the fetus had arthrogryposis multiplex congenita due to trans-placental transfer of anti-acetylcholine receptor antibodies. The baby was delivered by elective caesarean section at 34weeks of gestation but died in the immediate postpartum period. The mother underwent thymectomy within five weeks of delivery. The implications of myasthenia gravis for both the mother and baby are discussed. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372957 Mon, 29 Nov 2010 00:00:00 +0100 4372957 http://www.medworm.com/index.php?rid=4372953&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001305%2Fabstract%3Frss%3Dyes Conclusion: Internal iliac balloon catheters can be inserted electively or in an emergency in patients at risk of major obstetric haemorrhage. Although useful in some, they are not universally effective; patients are still at risk of significant blood loss and at high risk of requiring a hysterectomy. In our experience, catheters can be placed electively or in an emergency but have been associated with adverse outcomes. These lessons have been important learning points in perioperative management. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372953 Mon, 29 Nov 2010 00:00:00 +0100 4372953 http://www.medworm.com/index.php?rid=4372952&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001457%2Fabstract%3Frss%3Dyes Abstract: Lipid emulsion has recently emerged as a potential antidote for local anesthetic systemic toxicity. This review examines the literature and guidelines for administration of lipid emulsion in the setting of advanced cardiac life support. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372952 Mon, 29 Nov 2010 00:00:00 +0100 4372952 http://www.medworm.com/index.php?rid=4372945&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001329%2Fabstract%3Frss%3Dyes Conclusion: Anesthetic requirements for sevoflurane, as measured by Bispectral Index, decrease in laboring versus non-laboring parturients undergoing cesarean delivery. Prolactin, progesterone and cortisol do not appear to be responsible for this observation. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372945 Mon, 29 Nov 2010 00:00:00 +0100 4372945 http://www.medworm.com/index.php?rid=4372969&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001330%2Fabstract%3Frss%3Dyes We report the case of a 21-year-old pregnant woman at 29weeks of gestation who was admitted with H1N1-related adult respiratory distress syndrome (ARDS) caused by a resistant Acinetobacter infection for which she was treated with IgM-enriched intravenous immunoglobulin (IVIG). (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372969 Fri, 26 Nov 2010 00:00:00 +0100 4372969 http://www.medworm.com/index.php?rid=4372959&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001470%2Fabstract%3Frss%3Dyes Abstract: Gorham–Stout disease is a rare disorder of bone loss and proliferation of lymphatic and vascular tissue (lymphangiomatosis). A 30-year-old nulliparous woman with Gorham–Stout disease presented at 8weeks of gestation with a fused cervical spine. At 31weeks she developed basilar invagination and neurological symptoms that were managed with a neck brace. Anesthetic considerations were those of airway compromise, development of severe preeclampsia and Kasabach–Merritt coagulopathy. Elective tracheostomy was declined. She presented two days before a planned cesarean delivery at 35weeks in preterm labor. A semi-urgent cesarean delivery under spinal anesthetic proceeded uneventfully, with an otolaryngologist present in case a surgical airway was required. Mother and baby were disc... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372959 Fri, 26 Nov 2010 00:00:00 +0100 4372959 http://www.medworm.com/index.php?rid=4372975&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001822%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372975 Wed, 17 Nov 2010 00:00:00 +0100 4372975 http://www.medworm.com/index.php?rid=4372972&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001068%2Fabstract%3Frss%3Dyes The 2005 CEMACH report identified two deaths in which intracranial haemorrhage was thought to have occurred as a result of the hypertensive response to tracheal intubation during induction of anaesthesia for emergency caesarean section. The report specifically recommended: “Anaesthetists should anticipate an additional rise in blood pressure at intubation in women with severe preeclampsia” and that “the anaesthetist should be given as much time as possible to try to prevent the presser effects of intubation”. A recently published case series of 28 women in the USA supports the CEMACH report, suggesting that a systolic blood pressure of >160mmHg in this patient group is associated with an increased risk of intracranial haemorrhage. There is little evidence on which to base a recomme... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372972 Fri, 12 Nov 2010 00:00:00 +0100 4372972 http://www.medworm.com/index.php?rid=4372971&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X1000110X%2Fabstract%3Frss%3Dyes In the obstetric population the incidence of epidural abscesses and meningitis are thankfully rare but if they occur can have devastating results. Consequently, skin disinfection and aseptic practice are of paramount importance. Although there is evidence that alcoholic chlorhexidine is the most effective skin disinfectant, there is no conclusive evidence that a particular concentration is superior. The use of chlorhexidine is not without risk being a known neurotoxin which can cause arachnoiditis. It is a logical deduction that there could be an increased risk of arachnoiditis with stronger solutions. Conversely, it could be argued that stronger solutions may provide superior skin disinfection. Like serious infective complications, arachnoiditis is extremely rare but can be equally devast... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372971 Fri, 12 Nov 2010 00:00:00 +0100 4372971 http://www.medworm.com/index.php?rid=4372964&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001093%2Fabstract%3Frss%3Dyes We describe an epidural pump malfunction that resulted in the delivery of an overdose of ropivacaine 0.2% to two patients. A 32-year-old nulliparous woman at 39weeks of gestation, presented to the labor and delivery ward. An epidural catheter was uneventfully placed in the L3–4 interspace and, following an induction dose of 10mL 0.2% ropivacaine with 100μg fentanyl, she received a continuous epidural infusion of 0.2% ropivacaine at 8mL/h with a patient-controlled epidural analgesia (PCEA) bolus of 6mL once every 30min via an infusion pump (Curlin Medical Inc, Huntington Beach, CA 92649). The patient did not receive any self- or clinician-administered boluses during labor. Six hours later she had a normal vaginal delivery with episiotomy, after repair of which the infusion pump was turne... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372964 Fri, 12 Nov 2010 00:00:00 +0100 4372964 http://www.medworm.com/index.php?rid=4372956&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X1000107X%2Fabstract%3Frss%3Dyes We describe a patient with myotonia who developed hypertonus immediately following the administration of uterotonic agents. A 24-year-old, G2P1 at 31 weeks of gestation with a history of acetazolamide-responsive myotonia presented with premature rupture of membranes. During cesarean delivery she experienced significant hypertonus of the upper limbs, shoulders, fingers, and mouth immediately after intravenous administration of oxytocin 5 IU and methylergometrine maleate 0.2mg. The mechanism underlying increased muscle tone in response to these drugs remains unclear. Anesthesiologists should be especially attentive to the administration of uterotonic drugs during the management of pregnant myotonia patients. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372956 Fri, 12 Nov 2010 00:00:00 +0100 4372956 http://www.medworm.com/index.php?rid=4372968&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001044%2Fabstract%3Frss%3Dyes An inherited defect of coagulation factor V (FV) is a rare bleeding disorder with a prevalence of 1 in 1 000 000. Defects can be classified as quantitative (type I) or qualitative (type II). Severe type I deficiency is defined as a level of FV antigen (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372968 Mon, 01 Nov 2010 00:00:00 +0100 4372968 http://www.medworm.com/index.php?rid=4372967&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X1000097X%2Fabstract%3Frss%3Dyes Rapid administration of oxytocin has been reported to cause decreased systemic vascular resistance (SVR), tachycardia and maternal death. A 29-year-old woman at 36weeks of gestation presented with increasing dyspnea. She reported a recent chest infection and a history of a patent ductus arteriosus (PDA) with Eisenmenger’s Syndrome (ES) diagnosed 2years previously. An echocardiogram demonstrated a large PDA with severe pulmonary hypertension, which was treated with inotropic support and diuretics. Hemoptysis accompanied by fetal distress four days after admission prompted emergency cesarean delivery. In the operating room, the patient was placed in a seated position due to her orthopnea; her baseline SpO2 recorded from a pulse oximeter on her right hand was 75% on facemask oxygen. An arte... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372967 Mon, 01 Nov 2010 00:00:00 +0100 4372967 http://www.medworm.com/index.php?rid=4372966&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10000981%2Fabstract%3Frss%3Dyes We report a case that illustrates the importance of considering non-anaesthetic and non-surgical causes of neurological disease in patients with new onset postpartum symptoms. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372966 Mon, 01 Nov 2010 00:00:00 +0100 4372966 http://www.medworm.com/index.php?rid=4372965&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10000968%2Fabstract%3Frss%3Dyes Wegener’s granulomatosis is an ANCA-associated systemic disease characterized by necrotizing granulomatous vasculitis of upper and lower respiratory tracts, often associated with disseminated small vessel vasculitis and necrotizing glomerulonephritis. Clinical manifestation and organ involvement vary widely. Without effective therapy, mortality is high. The rarity of the disease, combined with a peak incidence in the fourth and fifth decades of life, makes an association with pregnancy rare. Subglottic stenosis (SGS) is known to complicate Wegener’s granulomatosis in 6–23% of cases and results from circumferential inflammation, oedema and fibrosis at the level of the cricoid cartilage, up to 4cm below the vocal cords. The effect of pregnancy on the course of Wegener’s and associate... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372965 Mon, 01 Nov 2010 00:00:00 +0100 4372965 http://www.medworm.com/index.php?rid=4372951&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001111%2Fabstract%3Frss%3Dyes Abstract: Pulmonary embolism is the leading cause of maternal death in the developed world. The clinical diagnosis of pulmonary embolism is particularly challenging in pregnant patients as physiologic changes of pregnancy can mimic symptoms of pulmonary embolism or deep venous thrombosis. Clinical decision and imaging algorithms for venous thromboembolic disease have been proposed in the literature for the general population, but have not undergone wide-scale validation in pregnant patients. Laboratory evaluation of D-dimer levels has likewise been established as a viable screening method in the general population but remains controversial in pregnant patients. Regardless of whether D-dimer levels are used in this population, the clinician must often rely on imaging tests to confirm or exc... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372951 Mon, 01 Nov 2010 00:00:00 +0100 4372951 http://www.medworm.com/index.php?rid=4372944&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10000956%2Fabstract%3Frss%3Dyes Conclusion: The use of general anesthesia for cesarean delivery is low and declining. These trends may reflect the early and increasing use of neuraxial techniques, particularly in parturients with co-existing morbidities. A significant reduction in exposure of trainees to obstetric general anesthesia has been observed. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372944 Mon, 01 Nov 2010 00:00:00 +0100 4372944 http://www.medworm.com/index.php?rid=4372955&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001007%2Fabstract%3Frss%3Dyes Abstract: An intravenous bolus of phentolamine was inadvertently given to a parturient during an emergency caesarean section following delivery of her infant when the intention had been to give an intravenous bolus of 5 IU Syntocinon. Root cause analysis identified a series of errors originating in the hospital pharmacy when one drug package was mistakenly issued in place of another. Subsequent checks failed to detect the original mistake. The final and most important check immediately before intravenous administration was also at fault. This case highlights a systems failure that permitted issue, transportation and administration of the wrong drug to a parturient. Robust measures to ensure avoidance of drug administration errors should be evaluated and introduced where possible. (Source: ... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372955 Fri, 29 Oct 2010 00:00:00 +0100 4372955 http://www.medworm.com/index.php?rid=4004454&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001238%2Fabstract%3Frss%3Dyes (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4004454 Wed, 29 Sep 2010 12:18:34 +0100 4004454 http://www.medworm.com/index.php?rid=4372974&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10000889%2Fabstract%3Frss%3Dyes This is the fifth edition of the handbook from the Harvard Medical School and is marked by the addition of two new authors. The book, which is divided into nineteen chapters, is an A5-sized paperback and aimed primarily at obstetric anaesthetists in training. The early chapters concentrate on basic science relevant to obstetric anaesthesia such as maternal physiological changes in pregnancy, local anaesthetic pharmacology, perinatal pharmacology, uteroplacental blood flow and the physiology of pain in labour. The remainder of the book covers clinical topics including pain relief for labour, anaesthesia for caesarean section, care of high-risk pregnancy, incidental surgery in pregnancy and maternal mortality and morbidity. Various practice guidelines and summaries are included in three appe... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4372974 Tue, 14 Sep 2010 00:00:00 +0100 4372974 http://www.medworm.com/index.php?rid=4004490&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10000890%2Fabstract%3Frss%3Dyes A 27-year-old multiparous woman with transverse myelitis (TM) presented at 13 weeks of gestation to our anaesthetic clinic, prior to elective cerclage for cervical incompetence. Following an acute episode of TM six years previously, magnetic resonance imaging had demonstrated swelling in the lower thoracic spinal cord, commensurate with a demyelinating lesion. After a protracted period she regained full sensation but had residual muscle weakness below the waist. In her first pregnancy she had delivered vaginally without anaesthetic involvement although her discharge was delayed because of immobility from muscle weakness. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4004490 Mon, 13 Sep 2010 23:00:00 +0100 4004490 http://www.medworm.com/index.php?rid=4004489&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001159%2Fabstract%3Frss%3Dyes We report a case of herpes simplex meningitis following epidural analgesia in labour complicated by accidental dural puncture. A 25-year-old (G1P0) healthy woman at 41weeks of gestation presented to hospital for induction of labour. She requested epidural analgesia and placement was complicated by accidental dural puncture. The catheter was placed intrathecally and 2.5mg bupivacaine with 25μg fentanyl were given; this dosing regimen repeated at 2-hourly intervals. Six hours later, she underwent emergency caesarean section (CS) for fetal distress. She received 12mg bupivacaine and 25μg fentanyl preoperatively and 150mg intrathecal morphine at the end of surgery before catheter removal. A healthy male infant weighing 4210g was delivered. (Source: International Journal of Obstetric Anesthes... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4004489 Mon, 13 Sep 2010 23:00:00 +0100 4004489 http://www.medworm.com/index.php?rid=4004488&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001056%2Fabstract%3Frss%3Dyes We report three pregnant patients with severe respiratory failure and acute respiratory distress syndrome (ARDS). (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4004488 Mon, 13 Sep 2010 23:00:00 +0100 4004488 http://www.medworm.com/index.php?rid=4004485&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10000427%2Fabstract%3Frss%3Dyes We report the usefulness of a continuous cardiac output monitor to assess tissue oxygen delivery (DO2) in severe postpartum anemia. A 24-year-old (163cm, 51kg) primiparous Jehovah’s Witness with a baseline hemoglobin of 16.3g/dL, had a term vaginal delivery accompanied by an estimated blood loss of 1450mL. Ongoing bleeding required vaginal packing and surgery 10h postpartum. A FloTrac™/Vigileo™ (software 1.07) was placed in the radial artery to assess cardiac index (CI) and stroke volume variation (SVV). Blood loss was replaced with colloids and crystalloids to maintain a target of CI>3L/min/m2 and SVV (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4004485 Mon, 13 Sep 2010 23:00:00 +0100 4004485 http://www.medworm.com/index.php?rid=4004482&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001032%2Fabstract%3Frss%3Dyes We thank Drs Tan and Sia for their comments regarding our labor and postcesarean analgesia studies of polymorphism (304A>G) at the mu-opioid receptor (OPRM1). We designed the study to identify differences in pain outcomes between women homozygous for the wild-type allele (304AA) and women hetero- or homozygous for the mutant allele because a previous study by one of us (R.L.) found a significant difference in the ED50 for intrathecal fentanyl for labor analgesia between these two groups. As acknowledged in our paper, our negative results differ from those of a study performed in Singapore in a Han Chinese population by Drs Sia and Tan’s group. When we analyzed our data using the three groups suggested by Drs Tan and Sia (304AA, 304AG, 304GG) there was no difference among the groups in ei... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4004482 Mon, 13 Sep 2010 23:00:00 +0100 4004482 http://www.medworm.com/index.php?rid=4004481&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10001172%2Fabstract%3Frss%3Dyes We read with interest the report by Wong et al. which concluded that there was no association between intrathecal opioid analgesia and OPRM1 variant G allele (118A>G or N40D). It is a commendable effort which aimed to examine the association of the polymorphism with the duration of intrathecal fentanyl in labouring women and the amount of rescue analgesia for the 72h following intrathecal morphine injection for planned cesarean deliveries. (Source: International Journal of Obstetric Anesthesia) International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4004481 Mon, 13 Sep 2010 23:00:00 +0100 4004481 http://www.medworm.com/index.php?rid=4004478&cid=s_35741_5_f&fid=35741&url=http%3A%2F%2Fwww.obstetanesthesia.com%2Farticle%2FPIIS0959289X10000877%2Fabstract%3Frss%3Dyes I thank the authors for providing information that was not provided in the original publication. The purpose of the editorial was to highlight how the current developments in interventional radiology can influence the future management of women with placenta accreta. It is understandable that obstetricians prefer performing cesarean hysterectomy in conventional operating rooms. Likewise, interventional radiologists prefer performing placement of intra-arterial catheters and subsequent embolization in interventional radiology suites due to better quality of imaging. However, in the future, all specialists must muster skills and training to perform their part in novel surroundings. There is a learning curve for any new intervention and with time, the novel care becomes a routine. We have see... International Journal of Obstetric Anesthesia journals http://www.medworm.com/rss/comments.php?id=4004478 Mon, 13 Sep 2010 23:00:00 +0100 4004478