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https://www.readbyqxmd.com/read/29657082/horner-s-syndrome-following-obstetric-neuraxial-blockade-a-systematic-review-of-the-literature
#1
D J Chambers, K Bhatia
Horner's syndrome is a rarely reported complication of neuraxial blockade. In obstetric practice, the neurological signs of Horner's syndrome may cause anxiety amongst patients and healthcare staff, but more importantly may herald the onset of maternal hypotension. Medline, CINAHL, and EMBASE databases were searched to identify cases of Horner's syndrome following obstetric neuraxial blockade. Anaesthetic technique, clinical features, anaesthetic management of the Horner's syndrome and time to resolution were assessed...
March 17, 2018: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/29628561/norepinephrine-versus-ephedrine-to-maintain-arterial-blood-pressure-during-spinal-anesthesia-for-cesarean-delivery-a-prospective-double-blinded-trial
#2
Ali Mohamed Ali Elnabtity, Mohamed Foad Selim
Background: Ephedrine was conventionally regarded as the first-choice drug to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, due to its stimulant activity on α- and β-adrenergic receptors. Norepinephrine is a weak β-adrenergic and potent α-adrenergic receptor agonist. Therefore, it may be suitable for maintaining blood pressure with less chronotropic effects compared to ephedrine. Patients and Methods: One hundred and forty healthy patients having cesarean delivery under spinal anesthesia were randomized to Group N ( n = 61) who received a prophylactic bolus of norepinephrine 5 μg intravenous (i...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29520867/randomised-double-blind-comparison-of-bolus-phenylephrine-or-ephedrine-for-treatment-of-hypotension-in-women-with-pre-eclampsia-undergoing-caesarean-section
#3
M Mohta, S Duggal, G T Chilkoti
Treatment of post-spinal hypotension during caesarean section assumes special concern in pre-eclamptic patients due to a compromised fetoplacental circulation and increased risk of placental hypoperfusion. Phenylephrine and ephedrine are the most commonly used vasopressors, although the best choice is still not clear. We studied 80 pre-eclamptic women with a singleton pregnancy who underwent caesarean section with spinal anaesthesia, and who developed hypotension defined as a decrease in systolic arterial pressure ≥ 20% from baseline or absolute value < 100 mmHg...
March 9, 2018: Anaesthesia
https://www.readbyqxmd.com/read/29516705/comparison-of-the-effects-of-low-doses-of-dexmedetomidine-and-remifentanil-on-the-maternal-haemodynamic-changes-during-caesarean-delivery-in-patients-with-severe-preeclampsia-a-randomised-trial
#4
Mohamed R El-Tahan, Samah El Kenany, Ehsan M Abdelaty, Eiad A Ramzy
BACKGROUND: Preoperative remifentanil administration blunts haemodynamic responses to tracheal intubation in parturients with severe preeclampsia. We hypothesised that the preoperative administration of low doses of remifentanil or dexmedetomidine would lead to comparable maternal neurohormonal responses and neonatal outcomes in patients with severe preeclampsia. METHODS: Parturients diagnosed with severe preeclampsia undergoing caesarean delivery were randomly allocated to receive remifentanil (0...
March 7, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29461392/combined-colloid-preload-and-crystalloid-coload-versus-crystalloid-coload-during-spinal-anesthesia-for-cesarean-delivery-a-randomized-controlled-trial
#5
Mohamed Mohamed Tawfik, Amany Ismail Tarbay, Ahmed Mohamed Elaidy, Karim Ali Awad, Hanaa Mohamed Ezz, Mohamed Ahmed Tolba
BACKGROUND: The optimal strategy of fluid administration during spinal anesthesia for cesarean delivery is still unclear. Ultrasonography of the inferior vena cava (IVC) has been recently used to assess the volume status and predict fluid responsiveness. In this double-blind, randomized controlled study, we compared maternal hemodynamics using a combination of 500-mL colloid preload and 500-mL crystalloid coload versus 1000-mL crystalloid coload. We assessed the IVC at baseline and at subsequent time points after spinal anesthesia...
February 14, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29457115/comparison-of-inflationary-non-invasive-blood-pressure-inibp-monitoring-technology-and-conventional-deflationary-non-invasive-blood-pressure-dnibp-measurement-in-detecting-hypotension-during-cesarean-section
#6
Akiko Yamashita, Shingo Irikoma
Background: The Nihon Kohden linear inflationary non-invasive blood pressure (iNIBP) monitoring technology is an oscillometric device that measures blood pressure by detecting oscillations during inflation. Systolic blood pressure can be recorded without overinflating the cuff higher than the true systolic pressure. Thus, total time taken for inflation and deflation is shorter than that by the conventional deflation devices. In this study, the ability of iNIBP to detect maternal hypotension during cesarean section faster than deflationary non-invasive blood pressure (dNIBP) monitoring devices under clinical settings was evaluated prospectively...
2018: JA Clinical Reports
https://www.readbyqxmd.com/read/29416149/maternal-and-anaesthesia-related-risk-factors-and-incidence-of-spinal-anaesthesia-induced-hypotension-in-elective-caesarean-section-a-multinomial-logistic-regression
#7
Atousa Fakherpour, Haleh Ghaem, Zeinabsadat Fattahi, Samaneh Zaree
Background and Aims: Although spinal anaesthesia (SA) is nowadays the preferred anaesthesia technique for caesarean section (CS), it is associated with considerable haemodynamic effects, such as maternal hypotension. This study aimed to evaluate a wide range of variables (related to parturient and anaesthesia techniques) associated with the incidence of different degrees of SA-induced hypotension during elective CS. Methods: This prospective study was conducted on 511 mother-infant pairs, in which the mother underwent elective CS under SA...
January 2018: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/29415779/severe-bicuspid-aortic-stenosis-in-pregnancy-balancing-the-risk-of-prematurity-and-maternal-mortality
#8
Chinedu Nwabuobi, Megan McDowell, Sarah Običan
We report a case of combined severe aortic stenosis and regurgitation in a pregnant patient with a history of congenital bicuspid aortic valve. The patient presented at 22 weeks of gestation with angina and pre-syncopal symptoms. During her admission, she experienced intermittent episodes of non-sustained ventricular tachycardia and hypotension. A multi-disciplinary healthcare team was assembled to decide on the appropriate medical and surgical treatment options. At 28 weeks of gestation, the patient underwent a caesarean delivery immediately followed by a mechanical aortic valve replacement...
February 8, 2018: Cardiology in the Young
https://www.readbyqxmd.com/read/29406172/the-impact-of-neuraxial-clonidine-on-postoperative-analgesia-and-perioperative-adverse-effects-in-women-having-elective-caesarean-section-a-systematic-review-and-meta-analysis
#9
REVIEW
T K Allen, B M Mishriky, R Y Klinger, A S Habib
Neuraxial clonidine improves postoperative analgesia in the general surgical population. The efficacy and safety of neuraxial clonidine as a postoperative analgesic adjunct in the Caesarean section population still remains unclear. This systematic review and meta-analysis aims to evaluate the effect of perioperative neuraxial clonidine on postoperative analgesia in women having Caesarean section under neuraxial anaesthesia. We included randomized controlled trials comparing the analgesic efficacy of the perioperative administration of neuraxial clonidine alone or in combination with a local anaesthetic and/or opioids in women having elective Caesarean section under neuraxial anaesthesia when compared with placebo...
February 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29398754/the-effect-of-prophylactic-infusion-of-combined-ephedrin-and-phenylephrine-on-maternal-hemodynamic-after-spinal-anesthesia-for-cesarean-section-a-randomized-clinical-trial
#10
Simin Atashkhoie, Hojat Pourfathi, Bahman Naghipour, Shahla Meshgi
Several techniques have been proposed to prevent hypotension in obstetric patients. Ephedrine and phenylephrine are individually used to prevent maternal hypotension; however, each has its own drawbacks. Some researchers have reported that the infusion of combined ephedrine and phenylephrine immediately after spinal anesthesia for cesarean delivery reduces the incidence of maternal hypotension. Other studies have indicated that the combination is not superior to the infusion of an individual agent. The present study aimed to evaluate the effect of prophylactic infusion of ephedrine and phenylephrine before the induction of spinal anesthesia for cesarean section on maternal hemodynamic...
January 2018: Iranian Journal of Medical Sciences
https://www.readbyqxmd.com/read/29373334/comparison-of-double-intravenous-vasopressor-automated-system-using-nexfin-versus-manual-vasopressor-bolus-administration-for-maintenance-of-haemodynamic-stability-during-spinal-anaesthesia-for-caesarean-delivery-a-randomised-double-blind-controlled-trial
#11
Ban Leong Sng, Wei Du, Man Xin Lee, Farida Ithnin, Deepak Mathur, Wan Ling Leong, Rehena Sultana, Nian-Lin R Han, Alex Tiong Heng Sia
BACKGROUND: Hypotension is a common side effect of spinal anaesthesia during caesarean delivery and is associated with maternal and foetal adverse effects. We developed an updated double intravenous vasopressor automated (DIVA) system that administers phenylephrine or ephedrine based on continuous noninvasive haemodynamic monitoring using the Nexfin device. OBJECTIVE: The aim of our present study is to compare the performance and reliability of the DIVA system against Manual Vasopressor Bolus administration...
January 25, 2018: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29334907/hemodynamic-effects-of-lateral-tilt-before-and-after-spinal-anesthesia-during-cesarean-delivery-an-observational-study
#12
Ahmed Hasanin, Remoon Soryal, Tarek Kaddah, Sabah Abdel Raouf, Yaser Abdelwahab, Khaled Elshafaei, Mohamed Elsayad, Bassant Abdelhamid, Reham Fouad, Doaa Mahmoud, Yasmin Hassabelnaby
BACKGROUND: Post-spinal hypotension is a common maternal complication during cesarean delivery. Aortocaval compression by the gravid uterus has been assumed as a precipitating factor for post-spinal hypotension. The role of left lateral tilting position in improving maternal cardiac output after subarachnoid block (SAB) is unclear. The aim of this work is to investigate the effect of left lateral tilting on maternal hemodynamics after SAB. METHODS: A prospective observational study was conducted including 105 full term pregnant women scheduled for cesarean delivery...
January 15, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29330635/hypotension-due-to-spinal-anesthesia-influences-fetal-circulation-in-primary-caesarean-sections
#13
K Lato, I Bekes, Peter Widschwendter, T W P Friedl, W Janni, F Reister, G Froeba, U Friebe-Hoffmann
PURPOSE: Hypotension due to spinal anesthesia is a well-known side effect in pregnant women receiving caesarean section. Little is known about its impact on fetal blood circulation. METHODS: 40 women with uncomplicated singleton term pregnancies prepared for caesarean section were prospectively evaluated by Doppler sonography before and immediately after spinal anesthesia. RESULTS: In 90% of the women, blood pressure significantly decreased after spinal anesthesia and 42...
March 2018: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/29325592/magnesium-sulphate-for-fetal-neuroprotection-to-prevent-cerebral-palsy-mag-cp-implementation-of-a-national-guideline-in-canada
#14
Dane A De Silva, Anne R Synnes, Peter von Dadelszen, Tang Lee, Jeffrey N Bone, Laura A Magee
BACKGROUND: Evidence supports magnesium sulphate (MgSO4) for women at risk of imminent birth at < 32-34 weeks to reduce the likelihood of cerebral palsy in the child. MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP) was a multifaceted knowledge translation (KT) strategy for this practice. METHODS: The KT strategy included national clinical practice guidelines, a national online e-learning module and, at MAG-CP sites, educational rounds, focus group discussions and surveys of barriers and facilitators...
January 11, 2018: Implementation Science: IS
https://www.readbyqxmd.com/read/29225576/vitamin-d-enhances-efficacy-of-oral-nifedipine-in-treating-preeclampsia-with-severe-features-a-double-blinded-placebo-controlled-and-randomized-clinical-trial
#15
Dan-Dan Shi, Yong Wang, Jun-Jun Guo, Ling Zhou, Na Wang
Vitamin D (VD) has exhibited immunomodulatory role in the pathogenesis of preeclampsia. We hypothesize VD potentiate nifedipine treatment for preeclampsia by shortened the time to control blood pressure and prolong time before subsequent hypertensive crisis. We conduct a randomized trial of 683 primigravid women with preeclampsia, who were assigned to different treatment groups, either nifedipine+placebo or nifedipine+VD orally, by random after screening. Primary endpoints include time to control hypertension and time before another hypertensive crisis...
2017: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/29209926/a-randomized-trial-of-phenylephrine-infusion-versus-bolus-dosing-for-nausea-and-vomiting-during-cesarean-delivery-in-obese-women
#16
Ronald B George, Dolores M McKeen, Jennifer E Dominguez, Terrence K Allen, Patricia A Doyle, Ashraf S Habib
PURPOSE: Hypotension is common after spinal anesthesia for Cesarean delivery. It is associated with nausea, vomiting, and fetal acidosis. Previous research on phenylephrine excluded obese subjects. We compared the incidence of intraoperative nausea and vomiting (IONV) in obese patients who received a prophylactic phenylephrine infusion vs those who received bolus dosing for the treatment of spinal-induced hypotension. METHODS: In this multicentre, double-blinded randomized controlled trial, 160 obese women undergoing elective Cesarean delivery under spinal anesthesia were randomized to receive a prophylactic phenylephrine infusion initiated at 50 μg·min-1 (and titrated according to a predefined algorithm) or 100 μg phenylephrine boluses to treat hypotension...
March 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/29151071/an-observational-cohort-study-of-3-units-versus-5-units-slow-intravenous-bolus-oxytocin-in-women-undergoing-elective-caesarean-delivery
#17
N Terblanche, P Otahal, A Messmer, P Wright, S Patel, K Nathan, J E Sharman
This study sought to compare postpartum blood loss and maternal outcomes after 3IU and 5IU oxytocin at elective caesarean delivery. In a prospective observational study, 73 women undergoing elective caesarean delivery under spinal anaesthetic received a slow I.V. injection of either 3IU (n = 35) or 5IU (n = 38) oxytocin after delivery. The main outcome was gravimetrically measured 24-hour postpartum blood loss with a non-inferiority margin of 300 mL. Uterine tone, phenylephrine dose, emesis and hypotension after oxytocin administration were secondary outcomes...
August 2017: Journal of Physiology and Pharmacology: An Official Journal of the Polish Physiological Society
https://www.readbyqxmd.com/read/29112650/maternal-pulse-pressure-and-the-risk-of-postepidural-complications-a-randomized-controlled-trial
#18
RANDOMIZED CONTROLLED TRIAL
Justin R Lappen, Stephen A Myers, Norman Bolen, Brian M Mercer, Edward K S Chien
OBJECTIVE: To test the hypothesis that increasing the intravenous fluid bolus volume at the time of epidural placement in women with narrow pulse pressure would reduce postepidural fetal heart rate (FHR) abnormalities, hypotension, and resuscitative obstetric interventions. METHODS: We performed a single-center randomized controlled trial. Eligible participants were normotensive with a nonanomalous singleton gestation at or after 35 weeks and with a narrow pulse pressure (less than 45 mm Hg) on admission...
December 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29092961/maternal-olmesartan-exposure-causing-neonatal-failure
#19
Antonio Pérez-Iranzo, Ana Nos Ferreres, Aranzazu Jarque Bou
Although angiotensin II receptor blockers (ARBs) are contraindicated during pregnancy, new cases are currently being reported.A 32-week preterm neonate was admitted after C-section due to maternal oligohydramnios. He presented with Potter phenotype, pulmonary hypoplasia with pneumothorax, systemic hypotension and anuria. He required chest drain insertion and continuous positive airway pressure (CPAP), volume expansion plus inotropic support with persistent renal failure. Mother confirmed olmesartan intake during entire pregnancy...
November 1, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29073508/lower-limbs-venous-compression-reduces-the-incidence-of-maternal-hypotension-following-epidural-analgesia-during-term-labor
#20
Violaine Peyronnet, Arnaud Roses, Aude Girault, Marie Pierre Bonnet, Francois Goffinet, Vassilis Tsatsaris, Edouard Lecarpentier
OBJECTIVE(S): Every year in France, 10% to 20% of the 600 000 women given epidural analgesia during labor experience hypotension, which in 15% of cases is associated with fetal heart rate abnormalities. The efficiency of lower limbs venous compression in preventing the occurrence of maternal hypotension after neuraxial anesthesia has already been demonstrated, but only in the context of scheduled cesarean section. We assessed the preventive effect of medical lower limbs venous compression on the incidence of maternal hypotension after epidural analgesia during spontaneous term labor...
October 16, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
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