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https://www.readbyqxmd.com/read/27898546/lateral-position-for-cesarean-delivery-because-of-severe-aortocaval-compression-in-a-patient-with-marfan-syndrome-a-case-report
#1
John C Coffman, Russell L Legg, Catherine F Coffman, Kenneth R Moran
Prompt recognition and management of hypotension resulting from aortocaval compression syndrome are essential to optimize the maternal and fetal outcomes. Management involves increasing leftward uterine displacement and sometimes full lateral positioning, although lateral position during cesarean delivery is typically considered to be impractical. We report an obstetric patient case of severe aortocaval compression syndrome resulting in hypotension and loss of consciousness that ultimately underwent cesarean delivery under general anesthesia in the lateral position...
November 28, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27884665/airway-management-for-cesarean-delivery-performed-under-general-anesthesia
#2
S Rajagopalan, M Suresh, S L Clark, B Serratos, S Chandrasekhar
BACKGROUND: With the increasing popularity of neuraxial anesthesia, there has been a decline in the use of general anesthesia for cesarean delivery. We sought to examine the incidence, outcome and characteristics associated with a failed airway in patients undergoing cesarean delivery under general anesthesia. METHODS: A retrospective review of airway management in women undergoing cesarean delivery under general anesthesia over an eight-year period from 2006-2013 at an academic medical center was conducted...
October 27, 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/27824749/treatment-decisions-at-the-time-of-miscarriage-diagnosis
#3
Courtney A Schreiber, Veronica Chavez, Paul G Whittaker, Sarah J Ratcliffe, Ebony Easley, Frances K Barg
OBJECTIVE: To describe the factors patients and physicians prioritize during first-trimester miscarriage management and assess what drives satisfaction with care. METHODS: We conducted a mixed-methods study of clinically stable women seeking surgical, medical, or expectant miscarriage treatment. Women with first-trimester fetal demise or anembryonic gestation (N=55) completed demographic and psychosocial surveys. Using purposive sampling, 45 (82%) completed in-depth interviews...
December 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27822105/the-danish-national-quality-database-for-births
#4
REVIEW
Charlotte Brix Andersson, Christina Flems, Ulrik Schiøler Kesmodel
AIM OF THE DATABASE: The aim of the Danish National Quality Database for Births (DNQDB) is to measure the quality of the care provided during birth through specific indicators. STUDY POPULATION: The database includes all hospital births in Denmark. MAIN VARIABLES: Anesthesia/pain relief, continuous support for women in the delivery room, lacerations (third and fourth degree), cesarean section, postpartum hemorrhage, establishment of skin-to-skin contact between the mother and the newborn infant, severe fetal hypoxia (proportion of live-born children with neonatal hypoxia), delivery of a healthy child after an uncomplicated birth, and anesthesia in case of cesarean section...
2016: Clinical Epidemiology
https://www.readbyqxmd.com/read/27804180/non-invasive-high-intensity-focused-ultrasound-treatment-of-the-placental-unit-preliminary-in-vivo-study-using-a-monkey-model-of-pregnancy
#5
J Caloone, C Huissoud, A Kocot, J Vincenot, C Dehay, P Giroud, P Misery, F Allias, R C Rudigoz, D Melodelima
OBJECTIVE: To demonstrate the feasibility and efficacy of high-intensity focused ultrasound (HIFU) to non-invasively treat placental tissues in a monkey model of pregnancy. MATERIALS AND METHODS: A toroidal HIFU transducer working at 2.5 MHz with an integrated ultrasound-imaging probe was used. Eight pregnant monkeys were exposed to HIFU treatment after anesthesia. Lesions on placental tissues were performed non-invasively by placing the HIFU probe on the skin. Fetal and maternal parameters, such as maternal heart rate, fetal heart rate, and subcutaneous and intra-amniotic fluid temperature, were recorded during HIFU exposure...
November 2, 2016: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27779353/mortality-following-congenital-diaphragmatic-hernia-repair-the-role-of-anesthesia
#6
Chulananda Goonasekera, Kamal Ali, Ann Hickey, Lekshmi Sasidharan, Malcolm Mathew, Mark Davenport, Anne Greenough
BACKGROUND: Mortality following surgical repair of congenital diaphragmatic hernia (CDH) remains high. The volume and type of perioperative intravenous fluid administered, baro-trauma, oxygen toxicity, and the duration of anesthesia are thought to affect outcome in surgical populations. AIMS: The aim of this retrospective observational study was to determine whether the perioperative volume or type of fluids and/or the duration of anesthesia were associated with postoperative mortality and if mortality was predicted by the oxygenation index (OI) prior to or following CDH surgical repair...
December 2016: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27746526/efficacy-of-lipophilic-vs-lipophobic-opioids-in-addition-to-hyperbaric-bupivacaine-for-patients-undergoing-lower-segment-caeserean-section
#7
Amit Agrawal, Veena Asthana, J P Sharma, Vineeta Gupta
BACKGROUND: Subarachnoid block is the preferred technique for providing anesthesia for patients undergoing cesarean section. Various pharmacological agents in added to local anesthetics (LA) modify their original effects in terms of block characteristics and quality of analgesia. However, there is ongoing debate about this practice of using adjuncts with LA. We tested whether addition of lipophilic versus lipophobic opioids to LA gives any clinical benefits to maternal and fetal outcome when used in these patients requiring spinal anesthesia...
September 2016: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/27741203/maternal-and-neonatal-outcomes-with-early-compared-with-delayed-pushing-among-nulliparous-women
#8
Lynn M Yee, Grecio Sandoval, Jennifer Bailit, Uma M Reddy, Ronald J Wapner, Michael W Varner, Steve N Caritis, Mona Prasad, Alan T N Tita, George Saade, Yoram Sorokin, Dwight J Rouse, Sean C Blackwell, Jorge E Tolosa
OBJECTIVE: To describe factors associated with delayed pushing and evaluate the relationship between delayed pushing and perinatal outcomes in nulliparous women with singleton term gestations. METHODS: This was a secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Assessment of Perinatal Excellence cohort of 115,502 women and their neonates born in 25 U.S. hospitals from 2008 to 2011. Nulliparous women with singleton, cephalic, nonanomalous term births who achieved 10-cm cervical dilation were included...
November 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27738550/propofol-related-infusion-syndrome-in-the-peripartum-period
#9
Akwugo A Eziefule, Solafa Elshatanoufy, Mili Thakur, Frederico G Rocha
Background Propofol is a widely known, commonly used drug. Complications can occur with the use of this drug, including propofol-related infusion syndrome (PRIS). PRIS, in the obstetric population, has not been documented; however, we report a case of a patient who developed PRIS after an emergent cesarean delivery of a preterm infant. Case Study A 35-year-old multigravida woman presented complaining of leakage of fluid and decreased fetal movement. Her pregnancy was complicated by methadone maintenance therapy due to a history of opioid abuse...
October 2016: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/27705970/successful-in-utero-percutaneous-fetoscopic-release-of-a-wrapped-pleuro-amniotic-shunt-around-the-fetal-arm-case-report-and-review-of-the-literature
#10
Ahmed A Nassr, Rodrigo Ruano, Jimmy Espinoza, Alireza A Shamshirsaz
BACKGROUND AND OBJECTIVES: Fetal pleural effusions are either primary or secondary to chromosomal or structural fetal abnormalities. In both cases, thoraco-amniotic shunts may be indicated to prevent life-threatening consequences. In this report, we describe a rare complication of shunts and successful in utero management of this complication. We also summarize the prior reports of shunt wrapping around fetal limbs and successful prenatal release of the shunts. DATA SOURCE: Search including PubMed, MEDLINE and EMBASE databases from inception till November 2015 was conducted for cases with shunt entrapment around fetal limbs with or without prenatal management...
October 6, 2016: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/27687377/a-randomized-trial-comparing-prophylactic-phenylephrine-and-ephedrine-infusion-during-spinal-anesthesia-for-emergency-cesarean-delivery-in-cases-of-acute-fetal-compromise
#11
Kajal Jain, Jeetinder Kaur Makkar, Siva Subramani Vp, Shalini Gander, Praveen Kumar
BACKGROUND: Previous evidence showed that use of phenylephrine was associated with higher umbilical artery pH (UA pH) than ephedrine after elective cesarean delivery (CD). However, the best choice of vasopressor and its effect on funic gases in cases of acute fetal compromise require additional studies. METHODS: Ninety parturients showing acute fetal compromise during intrapartum period and taken up for CD (category II) under spinal anesthesia were randomized to receive prophylactic infusion of ephedrine 2...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27687365/sonographic-evaluation-of-lumbar-interlaminar-space-opening-in-a-variety-of-patient-body-positions-for-optimal-neuraxial-anesthesia-delivery
#12
Dennis P Dimaculangan, Jonathan A Mazer, Luiz F Maracaja-Neto
OBJECTIVE: To find the position that provided the most comfort, as well as the widest L3-L4 interlaminar space opening. DESIGN: Pilot study. SETTING: Operating room. PATIENTS: Thirty-two healthy volunteers. INTERVENTIONS: L3-L4 interlaminar space was measured on volunteers assuming a baseline position (sitting upright) and 5 study positions: (1) sitting in fetal position, (2) sitting on a table tilted at 30°, (3) sitting while hugging an exercise ball, (4) sitting with midcalves on the table's edge, and (5) lying on one side in fetal position...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27684833/use-of-the-glidescope-video-laryngoscope-for-intubation-during-ex-utero-intrapartum-treatment-in-a-fetus-with-a-giant-cyst-of-the-4th-branchial-cleft-a-case-report
#13
Sung Hye Byun, So Young Lee, Seong Yeon Hong, Taeha Ryu, Baek Jin Kim, Jin Yong Jung
INTRODUCTION: In fetuses who are predicted to be at risk of catastrophic airway obstruction at delivery, the ex utero intrapartum treatment (EXIT) procedure is useful for securing the fetal airway while maintaining fetal oxygenation via placental circulation. Factors, including poor posture of the fetus and physician, narrow visual field, and issues of contamination in the aseptic surgical field, make fetal intubation during the EXIT procedure difficult. Herein, we report our experience of the usefulness of the GlideScope video laryngoscope (GVL) for intubation during the EXIT procedure...
September 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27645688/hypoxic-pulmonary-vasoconstriction-from-molecular-mechanisms-to-medicine
#14
Kimberly J Dunham-Snary, Danchen Wu, Edward A Sykes, Amar Thakrar, Leah Rg Parlow, Jeffrey D Mewburn, Joel L Parlow, Stephen L Archer
Hypoxic pulmonary vasoconstriction (HPV) is a homeostatic mechanism that is intrinsic to the pulmonary vasculature. Intrapulmonary arteries constrict in response to alveolar hypoxia, diverting blood to better-oxygenated lung segments, thereby optimizing ventilation-perfusion matching and systemic oxygen delivery. In response to alveolar hypoxia, a mitochondrial sensor dynamically changes reactive oxygen species and redox couples in PASMC. This inhibits potassium channels, depolarizes PASMC, activates voltage-gated calcium channels, and increases cytosolic calcium, causing vasoconstriction...
September 16, 2016: Chest
https://www.readbyqxmd.com/read/27644555/lung-regeneration-by-fetal-lung-tissue-implantation-in-a-mouse-pulmonary-emphysema-model
#15
Koh Uyama, Shoji Sakiyama, Mitsuteru Yoshida, Koichiro Kenzaki, Hiroaki Toba, Yukikiyo Kawakami, Kazumasa Okumura, Hiromitsu Takizawa, Kazuya Kondo, Akira Tangoku
The mortality and morbidity of chronic obstructive pulmonary disease are high. However, no radical therapy has been developed to date. The purpose of this study was to evaluate whether fetal mouse lung tissue can grow and differentiate in the emphysematous lung. Fetal lung tissue from green fluorescent protein C57BL/6 mice at 16 days' gestation was used as donor material. Twelve-month-old pallid mice were used as recipients. Donor lungs were cut into small pieces and implanted into the recipient left lung by performing thoracotomy under anesthesia...
2016: Journal of Medical Investigation: JMI
https://www.readbyqxmd.com/read/27629830/effect-of-fine-particulate-matter-pm2-5-on-rat-placenta-pathology-and-perinatal-outcomes
#16
Yi Liu, Ledan Wang, Fang Wang, Changzhong Li
BACKGROUND Fine particulate matter with aerodynamic diameters smaller than 2.5 μm (PM2.5) has been reported to cause adverse effects on human health. Evidence has shown the association between PM2.5 exposure and adverse perinatal outcomes, and the most common method is epidemiological investigation. We wished to investigate the impact of PM2.5 on placenta and prenatal outcomes and its related mechanisms in a rat model. MATERIAL AND METHODS Pregnant rats were exposed to a low PM2.5 dose (15 mg/kg) with intratracheal instillation at pregnant day 10 and day 18, while the controls received an equivalent volume normal saline...
September 15, 2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/27619509/remifentanil-for-labor-analgesia-a-comprehensive-review
#17
Yayoi Ohashi, Leyla Baghirzada, Hiroyuki Sumikura, Mrinalini Balki
Japan has seen significant developments in obstetric anesthesia in recent years, including the establishment of the Japanese Society of Obstetric Anesthesia and Perinatology. However, labor pain, which is one of the most important issues in obstetric practice, is still not treated aggressively. The rate of epidural administration for labor analgesia is very low in Japan as compared to other developed countries. Remifentanil has been used for labor analgesia, as part of general anesthesia for cesarean delivery, as well as for various fetal procedures around the world...
September 12, 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/27598547/pythagoras-and-cosines-the-skin-dural-sac-distance-and-optimal-angles-in-paramedian-spinal-anesthesia
#18
Anna Puigdellívol-Sánchez, Miguel A Reina, Xavier Sala-Blanch, Jaume Pomés-Talló, Alberto Prats-Galino
The classical recommendation for paramedian approaches is needle insertion 1-2 cm paramedian and an angle of 10°-15° medial-cephalad to the plane of the back, but contact with vertebrae is frequent. A mathematical approach to individualizing punctures is proposed on the basis of skin-dural sac distance (d): Optimal angle ∼ inverse cosine [d/ √(1+d^2) ] and the distance covered by the needle ∼ √(1+d^2) for 1 cm paramedian punctures. The inferred angles were compared to optimal angles leading to the central dorsal part of the dural sac from 1 to 2 cm paramedian, measured by Magnetic Resonance Imaging (MRI) in seven cases and in a short stature volunteer (1...
November 2016: Clinical Anatomy
https://www.readbyqxmd.com/read/27574464/managing-anesthesia-for-cesarean-section-in-obese-patients-current-perspectives
#19
REVIEW
Agnes M Lamon, Ashraf S Habib
Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients...
2016: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/27566025/evaluation-and-management-of-the-pregnant-patient-with-suspected-primary-musculoskeletal-tumor-or-metastatic-carcinoma-to-bone
#20
REVIEW
Varun Puvanesarajah, Andrea M Spiker, Brett A Shannon, Maureen Grundy, Adam S Levin, Carol D Morris
Primary musculoskeletal cancer and metastatic disease to bone in pregnant patients presents major treatment challenges. Although uncommon, musculoskeletal malignancies in pregnant women have been reported. When diagnosing and treating these patients, the mother's health must be managed appropriately while ensuring that fetal development is not deleteriously affected. Extensive radiographic imaging and more advanced techniques are often necessary to fully characterize the extent of disease. When possible, magnetic resonance imaging should be used instead of computed tomography to limit exposure of the conceptus to radiation...
September 2016: Surgical Oncology
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