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Forthcoming meetingsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 28, 2009 Category: Anesthesiology Tags: Book Review Source Type: journals

Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 28, 2009 Category: Anesthesiology Source Type: journals

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This A5 format paperback has British and American editors, and features contributors from the USA, UK, Canada, Israel, and Australia. They represent the specialties of obstetrics, gynaecology, fetal medicine, social science, surgery, medicine, biochemistry, molecular biology, dietetics, and anaesthetics. The writing style is predominantly academic, with frequent references to named authors and in some chapters a heavy use of statistics. This renders the book primarily of interest to clinicians and scientists rather than to lay readers and non-academic midwives. Some bullet point lists and pictures would have perhaps increa...
Source: International Journal of Obstetric Anesthesia - September 6, 2009 Category: Anesthesiology Authors: Martin Dresner Tags: Book Review Source Type: journals

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In reply We thank Drs Dudeja for their interest in our manuscript and the interesting and valid discussion made regarding compensated and decompensated disseminated intravascular coagulation (DIC). However, we must stress that DIC is primarily a clinical diagnosis, and whilst laboratory tests are undertaken to confirm clinical suspicion, no single test is sensitive or specific to definitively diagnose DIC. As DIC is a dynamic process, laboratory tests provide only a snapshot of a complex disease process. Hence a common and potentially fatal error in managing DIC is to correct abnormal laboratory results instead of treatin...
Source: International Journal of Obstetric Anesthesia - September 6, 2009 Category: Anesthesiology Authors: A Sinha, D Meldrum, B Sinha, AS Thakor Tags: Correspondence Source Type: journals

Postpartum rupture of a splenic artery aneurysm presenting as disseminated intravascular coagulationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
It is with great interest that we read the letter by Sinha et al. regarding the postpartum rupture of a splenic artery aneurysm presenting as disseminated intravascular coagulation (DIC). However, we believe there are contradictory findings in this case that are insufficient to label it as DIC. DIC is a syndrome ranging in severity from subclinical compensated activation of hemostatic factors (non-overt DIC) to a decompensated coagulopathy (overt DIC). Compensated DIC is not clinically evident and the usual laboratory tests for DIC can be normal. At times there may be thrombocytopenia, normal or even elevated fibrinogen co...
Source: International Journal of Obstetric Anesthesia - September 6, 2009 Category: Anesthesiology Authors: R.K. Dudeja, S.K. Dudeja Tags: Correspondence Source Type: journals

Difficult intubation during rapid sequence induction in a parturient with Ehlers-Danlos syndrome, hypermobility typeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: There have been several reports of resistance to local anaesthetic agents in women with Ehlers-Danlos syndrome, hypermobility type, also known as Ehlers-Danlos syndrome Type III. General anaesthesia with rapid sequence induction was performed for caesarean section due to prolonged second stage of labour, but intubation proved to be difficult. We propose that intubation difficulty probably arose from collapse of fibro-elastic tissues and adjoining C-shaped cartilages of the trachea with appropriately applied cricoid pressure. We found no other case reports of difficult intubation in patients with Ehlers-Danlos syn...
Source: International Journal of Obstetric Anesthesia - September 6, 2009 Category: Anesthesiology Authors: V. Sood, D.A. Robinson, I. Suri Tags: Case Reports Source Type: journals

Fatal respiratory thermal injury following accidental administration of carbon dioxide using the circle system for a cesarean deliveryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: A 37-year-old parturient underwent emergency cesarean delivery because of severe preeclampsia. After induction of general anesthesia, the oxygen saturation decreased. Volatile anesthetics were discontinued and examination of the anesthetic circuit and machine revealed a soda lime canister that was extremely hot. The patient was detached from the anesthetic machine and hand-ventilated with an external oxygen cylinder. The surgery was cancelled and the patient was extubated. Analysis of the cylinder connected to the anesthesia machine displayed 100% carbon dioxide. The patient developed progressive respiratory fail...
Source: International Journal of Obstetric Anesthesia - September 6, 2009 Category: Anesthesiology Authors: M.M. Aghdashi, R. Abbasivash, E. Hassani, H. Pirnejad Tags: Case Reports Source Type: journals

Morbidly obese patients should not be anaesthetised by trainees without supervisionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Obesity is now common amongst pregnant women, and its strong association with operative delivery means that obese women are more likely to require anaesthesia than the non-obese. There is also no doubt that obesity increases the risks of anaesthesia and some patients present technical challenges that are best faced by senior clinicians. But the motion proposes this level of care is required for all women with a body mass index (BMI) above 40kg/m2. Is this really necessary? (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 6, 2009 Category: Anesthesiology Authors: Martin Dresner Tags: Controversy Source Type: journals

Morbidly obese patients should not be anaesthetised by trainees without supervisionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
According to the Scotsman newspaper on Wednesday 26th September 2007, Scotland is the second fattest nation in the world with first place going to the USA. One in four Scottish adults is classified as obese, therefore I feel I have the experience to talk about this subject. I am going to concentrate on the problems caused by obesity and the reasons why I think trainees need supervision. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 6, 2009 Category: Anesthesiology Authors: A.F. McCrae Tags: Controversy Source Type: journals

A survey of the management of spinal-induced hypotension for scheduled cesarean deliveryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
ConclusionSignificant variations in practice exist in the prevention and treatment of spinal-induced hypotension. Fluid preloading and the prophylaxis and treatment of hypotension with ephedrine continue to be common practices. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 6, 2009 Category: Anesthesiology Authors: T.K. Allen, H.A. Muir, R.B. George, A.S. Habib Tags: Original Articles Source Type: journals

Spinal anesthesia in a patient receiving pentosan polysulfate sodiumEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report the management of a parturient receiving pentosan undergoing spinal anesthesia for cesarean delivery. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 3, 2009 Category: Anesthesiology Authors: C.R. Cambic, N. Higgins Tags: Correspondence Source Type: journals

The benefits offered by middle-income countries: a potential resource to improve clinical skillsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
I read with interest the recent article by Kopic and colleagues, and the accompanying editorial by Howell, regarding outreach programmes to the developing world, and their impact on the safety of obstetric anaesthesia. The article describes how the use of regional anaesthesia and analgesia increased after a two-week training programme. I derived most interest from the editorial, which expanded on the perceived needs in these developing-world institutions. Suggestions were made as to how the developed world could assist in improving poor outcomes associated with pregnancy in these areas. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 3, 2009 Category: Anesthesiology Authors: Phillipa Penfold Tags: Correspondence Source Type: journals

Dexmedetomidine for awake fiberoptic intubation in a parturient with spinal muscular atrophy type III for cesarean deliveryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report the hemodynamic, respiratory and sedative effects of dexmedetomidine on a parturient and neonate when used for awake fiberoptic intubation before cesarean section. A 35-year-old, gravida 4 para 0 aborta 3, 41-kg parturient at 35 weeks of gestation with spinal muscular atrophy presented for cesarean section. Dexmedetomidine was administered intravenously, total dose 1.84μg/kg over 38 minutes, followed by fiberoptic endotracheal intubation. Dexmedetomidine was then discontinued and general anesthesia was induced. The baby was delivered 68 minutes after the dexmedetomidine infusion was discontinued at which time bl...
Source: International Journal of Obstetric Anesthesia - September 3, 2009 Category: Anesthesiology Authors: M.M. Neumann, M.B. Davio, M.R. Macknet, R.L. Applegate Tags: Case Reports Source Type: journals

Peripartum anesthetic management of patients with aortic valve stenosis: a retrospective study and literature reviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Carefully titrated regional analgesia is usually well tolerated in patients undergoing vaginal or cesarean delivery even in the presence of severe aortic stenosis. Standard monitoring is usually adequate for vaginal delivery, but invasive monitoring may facilitate management in some patients. An arterial line allows close monitoring of systemic blood pressure. Facilities for close 24-48-h post-partum observation should be available. A multidisciplinary approach is needed. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 3, 2009 Category: Anesthesiology Authors: A.M. Ioscovich, E. Goldszmidt, A.V. Fadeev, S. Grisaru-Granovsky, S.H. Halpern Tags: Case Series and Review Source Type: journals

What’s new in obstetric anesthesiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article, which is the result of reviewing over 1400 scientific manuscripts to create the 2008 Ostheimer lecture, focuses on three key areas: recent advances in labor analgesia, post-cesarean delivery analgesia and novel developments surrounding the long- term outcomes of preeclampsia. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 3, 2009 Category: Anesthesiology Authors: Ruth Landau Tags: Review Source Type: journals

A randomized controlled study of whether the partner’s presence in the operating room during neuraxial anesthesia for cesarean delivery reduces patient anxietyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study compared anxiety in two groups of women undergoing elective cesarean delivery to ascertain if their partner’s presence during neuraxial anesthesia placement affected patients’ overall anxiety levels.Methods: Three hundred fifteen patient-partner dyads were randomized to two groups: group 1 partners were present in the operating room during neuraxial anesthesia placement while group 2 partners remained outside the operating room during placement. Before surgery, all patient-partner dyads completed a survey of demographics, anesthetic experiences and baseline anxiety. Anxiety levels were rated using a visual a...
Source: International Journal of Obstetric Anesthesia - September 3, 2009 Category: Anesthesiology Authors: M. Prabhu, L-F. Wang, A.R. Tait, A.S. Bullough Tags: Original Articles Source Type: journals

Low-dose epidural top up for emergency caesarean delivery: a randomised comparison of levobupivacaine versus lidocaine/epinephrine/fentanylEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Background: Levobupivacaine has a greater safety margin for cardiotoxicity than bupivacaine; consequently it has been recommended as the agent of choice for extending low-dose epidural analgesia for emergency caesarean section. We wished to compare the onset of levobupivacaine with that of a 2% lidocaine/epinephrine/fentanyl mixture.Methods: In a prospective, single blind study, we compared the speed of onset and efficacy of 20 mL of plain 0.5% levobupivacaine with 2% lidocaine/epinephrine 100 μg/fentanyl 100 μg for extending a previous low-dose labour epidural for emergency caesarean section in 100 patients.Re...
Source: International Journal of Obstetric Anesthesia - September 3, 2009 Category: Anesthesiology Authors: P. Balaji, P. Dhillon, I.F. Russell Tags: Original Articles Source Type: journals

Incidence and management of postpartum haemorrhage following the dissemination of guidelines in a network of 16 maternity units in FranceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion: The regional guidelines issued by the Aurore network were only partially followed. More effective guideline dissemination and implementation is required to improve the prevention and management of confirmed haemorrhage. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 3, 2009 Category: Anesthesiology Authors: C. Dupont, S. Touzet, C. Colin, C. Deneux-Tharaux, M. Rabilloud, H.J. Clement, J. Lansac, M.H. Bouvier Colle, R.C. Rudigoz, on behalf of Groupe PITHAGORE 6 Tags: Original Articles Source Type: journals

Blood transfusions: more is not necessarily betterEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Blood is good; more is better. Or is it? In this edition of the International Journal of Obstetric Anesthesia, we see this concept questioned through two retrospective audits of transfusion practices in the care of the obstetric patient. These studies originate from two countries: the United States and the United Kingdom, and from two different models of healthcare: fee for service and nationalized. Despite these differences, the articles highlight troubling similarities between US and UK transfusion practices. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 3, 2009 Category: Anesthesiology Authors: V. Clark, J.H. Waters Tags: Editorial Source Type: journals

A retrospective one-year single-centre survey of obstetric red cell transfusionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Overall there appeared to be a low threshold for red cell transfusion, with 31% of transfusions occurring despite a haemoglobin >7g/dL and in the absence of ongoing bleeding or symptoms of anaemia. Such transfusions are deemed inappropriate according to the Royal College of Obstetricians and Gynaecologists guidelines. The main recommendations are to implement an educational programme and guidelines in all obstetric units, reduce blood use and encourage documentation of appropriate consent. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 2, 2009 Category: Anesthesiology Authors: J. Parker, J. Thompson, S. Stanworth Tags: Original Articles Source Type: journals

Incompatibility of Braun Perifix® One epidural catheters with Opsite∗ sprayEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
After the introduction of Braun Perifix® One (B. Braun Medical Ltd., Melsungen, Germany) epidural catheter sets to the obstetric unit, it was noted that the black centimetre markings dissolved from the catheter on exposure to Opsite∗ spray film dressing (Smith & Nephew Medical Ltd., Hull, UK) used to fix it to the skin. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - August 26, 2009 Category: Anesthesiology Authors: C. Moody, S. Millett Tags: Correspondence Source Type: journals

Spinal anaesthetic failure from an easily overlooked defectEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report a case of suboptimal spinal anaesthesia as a result of an undetected defect on the syringe used for injection. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - August 24, 2009 Category: Anesthesiology Authors: A. Mathews, L. Radhakrishnan, P. Sharpe Tags: Correspondence Source Type: journals

Fogarty catheter sheath to assist extubationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The American Society of Anesthesiologists Task Force on Management of the Difficult Airway has made recommendations for an extubation strategy after difficult tracheal intubation, which include the use of an airway exchange catheter. We would like to report the successful use of a Fogarty catheter sheath to assist extubation. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - August 24, 2009 Category: Anesthesiology Authors: A. Panda, R. Sharma, A. Kumar, A.R. Bhalotra Tags: Correspondence Source Type: journals

Anesthetic management for cesarean delivery in a parturient with exacerbated hemophagocytic syndromeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report a 28-year-old primigravida with the onset of hemophagocytic syndrome and cyopenia at 23 weeks of gestation. A further exacerbation at 28 weeks of gestation brought on preterm labor. General anesthesia was provided successfully for cesarean delivery. The patient recovered completely after this episode. We suggest that early diagnosis, multi-disciplinary intervention, pre-operative correction of the hematological abnormalities, general anesthesia and close postoperative monitoring are necessary. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - August 24, 2009 Category: Anesthesiology Authors: C-T. Chien, F-J. Lee, H-N. Luk, C-C. Wu Tags: Case Reports Source Type: journals

An obstetric patient with neurocadiogenic syncopeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report the peripartum management of a 29-year-old primigravid patient with neurocardiogenic syncope, which had been diagnosed six years previously on tilt-table testing. General principles were applied to minimise the risk of precipitating syncopal episodes. She had an uneventful ventouse-assisted vaginal delivery under epidural anaesthesia in our obstetric high dependency unit. The optimum management of these patients has yet to be established. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - August 24, 2009 Category: Anesthesiology Authors: K. Jarvi, N. Osborn, N. Wall Tags: Case Reports Source Type: journals

Caesarean delivery in a parturient with a femoro-femoral crossover graft and congenital aortic stenosis repaired by the Ross procedureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report a case of a patient with congenital aortic stenosis previously repaired using the Ross procedure, who presented to our unit for urgent caesarean delivery. Management was complicated by moderate residual cardiac disease and the presence of a suprapubic femoro-femoral crossover graft. Following application of five-lead electrocardiogram and invasive blood pressure monitoring, anaesthesia was induced via combined spinal-epidural with epidural volume extension. A high transverse surgical approach avoided the course of the vascular graft, while further precautions included the immediate availability of vascular surgeo...
Source: International Journal of Obstetric Anesthesia - August 24, 2009 Category: Anesthesiology Authors: P. Richardson, S. Whittaker, U. Rajesh, M. Bonduelle, J. Morgan, M. Garry, C. Weston, C. Ferguson, L. Fligelstone Tags: Case Reports Source Type: journals

An observational study of anaesthesia and surgical time in elective caesarean section: spinal compared with general anaesthesiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion: In our hospital, the use of spinal anaesthesia was not associated with decreased intra-operative time efficiency compared to general anaesthesia for elective caesarean section. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - August 24, 2009 Category: Anesthesiology Authors: S. Ismail, A. Huda Tags: Original Articles Source Type: journals

A randomized controlled trial of the effect of combined spinal-epidural analgesia on the success of external cephalic version for breech presentationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Background: Improving the success of external cephalic version (ECV) for breech presentation may help avoid some cesarean deliveries. The results of randomized trials comparing the success of ECV with neuraxial analgesia compared to control are inconsistent. We hypothesized that combined spinal-epidural (CSE) analgesia would increase the success of ECV when compared with systemic opioid analgesia.Methods: Parturients with singleton breech presentation (n=96) were randomized to receive CSE analgesia with bupivacaine 2.5mg and fentanyl 15μg (CSE group) or intravenous fentanyl 50μg (SYS group) before ECV attempt. ...
Source: International Journal of Obstetric Anesthesia - August 16, 2009 Category: Anesthesiology Authors: J.T. Sullivan, W.A. Grobman, J.R. Bauchat, B.M. Scavone, S. Grouper, R.J. McCarthy, C.A. Wong Tags: Original Articles Source Type: journals

Acupuncture in the management of post-partum headache following neuraxial analgesiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We present two parturients with classical symptoms of low-pressure headache, who each received neuraxial labour analgesia without a documented dural puncture with a Tuohy needle. Both parturients were successfully managed using acupuncture rather than an epidural blood patch. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - August 9, 2009 Category: Anesthesiology Authors: A. Sharma, E. Cheam Tags: Case Reports Source Type: journals

Anaesthetic management of a pregnant patient with Takayasu’s disease undergoing abdominal aortic aneurysm repairEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report the successful anaesthetic management of repair of an abdominal aortic aneurysm in a patient with Takayasu’s disease at 14 weeks’ gestation. Anaesthesia was managed with combined epidural and general anaesthesia. During the intraoperative period haemodynamic parameters were well maintained. There were no episodes of haemodynamic fluctuations, oxygen desaturation or metabolic acidosis. Aortic cross-clamp time was 105min, blood loss around 1200mL, and central venous pressure maintained between 8 and 10cm H2O. There were no sudden changes in cardiac parameters, base deficit or urine output before or after cross ...
Source: International Journal of Obstetric Anesthesia - August 9, 2009 Category: Anesthesiology Authors: N. Bhardwaj, R. Babu, A. Behra Tags: Case Reports Source Type: journals

Intra-operative fluid warming in elective caesarean section: a blinded randomised controlled trialEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion: Warming intravenous fluids mitigates the decrease in maternal temperature during elective caesarean section under combined spinal-epidural anaesthesia and improves thermal comfort, but does not affect shivering. Intravenous fluids should be warmed routinely in elective caesarean section, especially for cases of expected long duration, but the use of pre-warmed fluids is as efficient and cheaper than using a Hotline® fluid warmer. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - August 9, 2009 Category: Anesthesiology Authors: M. Woolnough, J. Allam, C. Hemingway, M. Cox, S.M. Yentis Tags: Original Articles Source Type: journals

Perioperative anaesthetic management of high-order repeat caesarean section: audit of practice in a university-affiliated medical centreEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study summarizes our experience in the anaesthetic management of HORCS.Methods: The files of all parturients undergoing HORCS between January 1995 and August 2007 were reviewed to determine surgical times, rates and causes of conversion from neuraxial to general anaesthesia and the need to supplement neuraxial anaesthesia with intravenous sedation.Results: Parturients (n=108) were 35±4.5 years old with a gestational age of 37.5±1.5 weeks, weighed 88±20kg and had undergone 6±1 caesarean sections. Eighty-six (80%) were elective. Initial anaesthetic techniques included spinal (n=80, 74%), epidural (n=9, 8%), combined...
Source: International Journal of Obstetric Anesthesia - August 9, 2009 Category: Anesthesiology Authors: A. Ioscovich, E. Mirochnitchenko, S. Halpern, A. Samueloff, S. Grisaru-Granovsky, Y. Gozal, S. Einav Tags: Original Articles Source Type: journals

Retrospective analysis of transfusion outcomes in pregnant patients at a tertiary obstetric centerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Background: The decision to use red blood cell transfusion and/or blood products (fresh frozen plasma, platelets, cryoprecipitate) to manage obstetric hemorrhage or treat postpartum anemia is often made empirically by physicians. We performed a retrospective study to review transfusion outcomes in pregnant and postpartum patients at a large obstetric center.Methods: A retrospective, observational study was performed of obstetric in-patients who received red blood cell transfusion and/or blood products over a one-year period. Data abstracted included transfusion data, pre-transfusion hemoglobin (Hb) and lowest rec...
Source: International Journal of Obstetric Anesthesia - July 22, 2009 Category: Anesthesiology Authors: A.J. Butwick, P. Aleshi, M. Fontaine, E.T. Riley, L.T. Goodnough Tags: Original Articles Source Type: journals

A United Kingdom national obstetric intubation equipment surveyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion: Essential airway equipment was readily available in the event of a difficult obstetric intubation, with the exception of a fiberoptic bronchoscope. Few units conduct difficult airway training. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - July 21, 2009 Category: Anesthesiology Authors: A.S. Bullough, M. Carraretto Tags: Original Articles Source Type: journals

Forthcoming meetingsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 25, 2009 Category: Anesthesiology Source Type: journals

Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 25, 2009 Category: Anesthesiology Source Type: journals

Epidural catheter dilemma: a stretched catheter or erased markings?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The advantages of using the newer Flextip epidural catheters (Arrow International, Reading PA; B. Braun, Melsungen AG, Germany) include reduced incidences of paresthesia and accidental subarachnoid and intravascular placements. However, during removal, the catheter occasionally becomes stretched. We would like to report another problem with the Flextip catheter which can confound the stretching issue and make judging catheter depth more difficult. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 24, 2009 Category: Anesthesiology Authors: L. Hebbar, C. Tobin Tags: Correspondence Source Type: journals

Anaesthetic management of pregnancy complicated by a symptomatic arachnoid cystEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We read with interest the case report by Rupasinghe et al. of a woman with a large arachnoid cyst who underwent elective caesarean section using epidural anaesthesia. We would like to report a similar case involving a primigravida with a large posterior fossa arachnoid cyst. In this case, however, the patient had raised intracranial pressure (ICP) and was awaiting neurosurgical intervention. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 24, 2009 Category: Anesthesiology Authors: C. Larkin, F. Murphy, I. Browne Tags: Correspondence Source Type: journals

In replyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We would like to thank Dr Llau and Dr Gogarten for their insightful comments on our letter describing the use of labor epidural analgesia in a patient receiving fondaparinux. Dr Llau has correctly pointed out an important error in the letter with regards to the Sociedad Española de Anestesiología y Reanimación (SEDAR) Guidelines on Anticoagulant Drugs and Neuraxial Anesthesia. The SEDAR guidelines do not contraindicate the use of epidural anesthesia in patients receiving thromboprophylaxis with fondaparinux. We offer our sincere apologies for this error. The recommended time-frame between fondaparinux administration and...
Source: International Journal of Obstetric Anesthesia - May 24, 2009 Category: Anesthesiology Authors: Leinani Aiono-Le Tagaloa, Brendan Carvalho Tags: Correspondence Source Type: journals

Epidural labor analgesia in a patient receiving fondaparinuxEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
I read with interest the letter by Aiono-Le Tagaloa and Carvalho in which they describe the use of epidural analgesia in labor in a patient receiving fondaparinux. I would like to highlight some misconceptions presented in this article. Firstly, being responsible for the Spanish Guidelines on Anticoagulant Drugs and Neuraxial Anesthesia which is the official opinion of the Sociedad Española de Anestesiología y Reanimación (SEDAR), I would like to point out that the information given in Table I of the letter is incorrect. Spanish recommendations do not contraindicate the use of epidural anesthesia with an indwelling cath...
Source: International Journal of Obstetric Anesthesia - May 24, 2009 Category: Anesthesiology Authors: Juan Vicente Llau Tags: Correspondence Source Type: journals

Anesthesia for urgent sequential ventriculoperitoneal shunt revision and cesarean deliveryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report on a case of a 35-year-old primigravida at 36 weeks of gestation who was admitted to our hospital because of headache and cognitive and visual disturbances. At 13 years of age the patient had had a ventriculoperitoneal shunt for hydrocephalus related to an aqueduct stenosis. A computerized tomography scan of the brain showed moderate ventricular dilatation likely resulting from a malfunctioning shunt. On the second day after admission her level of consciousness and neurologic condition suddenly worsened and a second brain scan showed further enlargement of the ventricular system. After multidisciplinary consultat...
Source: International Journal of Obstetric Anesthesia - May 24, 2009 Category: Anesthesiology Authors: U. Freo, M. Pitton, M. Carron, C. Ori Tags: Case Reports Source Type: journals

Prone positioning for ARDS following blunt chest trauma in late pregnancyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: After a road traffic accident a pregnant patient at 34weeks of gestation developed ARDS following blunt chest trauma, for which she required mechanical ventilation. Twenty-four hours after the accident, ongoing severe hypoxaemia with atelectasis mainly in the dorsal parts of the lung led to the decision to manage the patient in the prone position. Prone positioning over 8h resulted in a persistent improvement of oxygenation, which allowed extubation the following day. At term, however, our patient was admitted with dyspnoea, chest pain, haemodynamic instability and fetal bradycardia, for which she required emerge...
Source: International Journal of Obstetric Anesthesia - May 24, 2009 Category: Anesthesiology Authors: S. Kenn, S. Weber-Carstens, K. Weizsaecker, S. Bercker Tags: Case Reports Source Type: journals

Off-licence use of medicines is bad medicine flying the flag of clinical freedomEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The proposition that drugs should not be used ‘off-label’ seems, at first glance, to be one that fits with the zeitgeist. We are all encouraged to practice evidence-based medicine. Our traditional clinical freedom is all too often shown to be an excuse for anecdote to trump scientific standards of proof, and guidelines, managed care and clinical pathways are being increasingly imposed, often for good reason and to good effect, to rein in our more maverick tendencies. Why then should we not restrict ourselves to using drugs for the indications and in the doses, routes of administration and formulations for which they ha...
Source: International Journal of Obstetric Anesthesia - May 24, 2009 Category: Anesthesiology Authors: D.G. Bogod Tags: Controversies Source Type: journals

Off-label use of medicines is bad medicine flying the flag of clinical freedomEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Let us start by recognising that, in daily practice, most clinicians do, from time to time, use licensed medicines in unlicensed indications. This doesn’t mean that the debate is a lost cause. Rather, I propose to limit the discussion to what I would label as “silly” or “non-evidenced” unlicensed use, specifically in relation to obstetrics. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 24, 2009 Category: Anesthesiology Authors: J.R. Sneyd Tags: Controversies Source Type: journals

The preparation and storage of anaesthetic drugs for obstetric emergencies: a survey of UK practiceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Background: Traditionally anaesthetic drugs for obstetrics are prepared as a contingency and stored until they are required for emergency use or have expired. Expiry is based on presumed reduction in sterility and efficacy although evidence for this is inconsistent. Preparation in advance introduces the risk of error and potential for tampering by a third party. Discarding and re-preparing drugs daily represents significant wastage with associated cost implications. We predicted that practice of drug preparation would differ widely across the UK, so conducted a national survey.Method: A postal questionnaire was s...
Source: International Journal of Obstetric Anesthesia - May 24, 2009 Category: Anesthesiology Authors: J.P. Stone, L.B. Fenner, T.R. Christmas Tags: Original Articles Source Type: journals

Minimum local analgesic concentrations of ropivacaine and levobupivacaine with sufentanil for epidural analgesia in labourEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Background: Sufentanil is often added to ropivacaine and levobupivacaine to provide epidural analgesia in labour. The aim of this study was to compare the analgesic potencies of epidural ropivacaine and levobupivacaine in combination with sufentanil 0.5μg/mL, using the minimum local analgesic concentration (MLAC) model with up-down sequential allocation.Methods: In this prospective study parturients with cervical dilation⩾3cm who requested epidural analgesia between 0800 and 1500 were enrolled. They were randomly allocated to receive 20mL of either ropivacaine (group R) or levobupivacaine (group L) both with s...
Source: International Journal of Obstetric Anesthesia - May 24, 2009 Category: Anesthesiology Authors: V. Boulier, P. Gomis, C. Lautner, H. Visseaux, M. Palot, J.-M. Malinovsky Tags: Original Articles Source Type: journals

Intravenous dexmedetomidine for obstetric anaesthesia and analgesia: converting a challenge into an opportunity?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Intrapartum neuraxial blocks have contended with and overcome many detractors to become the modus operandi for safe and effective analgesia in labour. Much research has been invested to enhance safety, efficacy and individualization of neuraxial blocks for women at various stages of labour. As a result, their use has dramatically escalated in recent years. The literature has been inundated by the constant quest for better techniques and drug concoctions for the induction and maintenance of neuraxial analgesia. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 24, 2009 Category: Anesthesiology Authors: Alex T. Sia, Ban L. Sng Tags: Editorials Source Type: journals

Fondaparinux and epidural anaesthesiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Aiono-Le Tagaloa and Carvalho describe a case in which epidural analgesia was given to a patient receiving fondaparinux for heparin-induced thrombocytopenia (HIT) without haemorrhagic complications. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 21, 2009 Category: Anesthesiology Authors: Wiebke Gogarten Tags: Correspondence Source Type: journals

Broken micro-tip spinal needleEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report the fracture of a new spinal needle during spinal anaesthesia in a morbidly obese parturient presenting for emergency caesarean section. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 19, 2009 Category: Anesthesiology Authors: M.W. Greenway, R. Vickers Tags: Correspondence Source Type: journals

A national survey of obstetric early warning systems in the United KingdomEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: The survey results support CEMACH recommendations for a nationally agreed obstetric EWS. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 19, 2009 Category: Anesthesiology Authors: R.D.J. Swanton, S. Al-Rawi, M.Y.K. Wee Tags: Forum Source Type: journals