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Muhammad Asghar Ali, Samina Ismail, Muhammad Sohaib, Asiyah Aman
Background and Aims: It is a common practice to add intrathecal lipophilic opioids to local anesthetics to improve the quality of subarachnoid block. This study was designed to find a dose of intrathecal fentanyl, which can improve the quality of surgical anesthesia with minimal side effects in parturients undergoing cesarean section under spinal anesthesia with intrathecal bupivacaine. Material and Methods: In a prospective randomized double-blind study, 243 parturients undergoing cesarean section under spinal anesthesia were randomly allocated to receive 10, 15, or 25 μg of intrathecal fentanyl with 10 mg of 0...
April 2018: Journal of Anaesthesiology, Clinical Pharmacology
Gregory A L Davies, Cynthia Maxwell, Lynne McLeod
OBJECTIVE: To review the evidence and provide recommendations for the counselling and management of obese parturients. OUTCOMES: Outcomes evaluated include the impact of maternal obesity on the provision of antenatal and intrapartum care, maternal morbidity and mortality, and perinatal morbidity and mortality. EVIDENCE: Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetrical anaesthesia, and perinatal morbidity and mortality...
August 2018: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Cynthia L Miltenburg, Todd F Duffield, Dorothee Bienzle, Elizabeth L Scholtz, Stephen J LeBlanc
Low total blood calcium concentration after calving has been demonstrated to be a risk factor for reduced neutrophil function. The objective of this study was to evaluate whether administration of an injectable calcium supplement product soon after calving increased neutrophil oxidative burst or phagocytosis capacity. Cows (n = 27) from 4 farms were blocked by parity and randomly assigned to receive either calcium gluconate (35% wt/vol) in combination with calcium glucoheptonate (10% wt/vol; Theracalcium, Vétoquinol Canada Inc...
August 9, 2018: Journal of Dairy Science
Nisha A Lakhi, Katherine Williamson, Michael L Moretti
BACKGROUND: Obese patients are at an increased risk of cesarean delivery and its associated wound complications. We present an alternative incision technique for obese parturients that avoids making a Pfannenstiel incision under the panniculus while still providing access to the lower uterine segment. TECHNIQUE: For our technique, an assistant uses Allis clamps to exert caudal traction on the patient's panniculus and a transverse skin incision is made under the umbilicus, 3 cm below the line joining the anterosuperior iliac crests...
August 6, 2018: Obstetrics and Gynecology
Yin-Fa Zhang, Fei Xiao, Wen-Ping Xu, Lin Liu
BACKGROUND: Phenylephrine infusion to prevent spinal-induced hypotension can attenuate cephalic spread of intrathecal bupivacaine. Therefore, we suspected the intrathecal dose requirement for bupivacaine may differ when using phenylephrine infusion to prevent spinal-induced hypotension in cesarean section. We designed a prospective, randomized study to determine the ED50 of hyperbaric bupivacaine for cesarean section under combined spinal-epidural anesthesia in healthy parturients with and without prophylactic phenylephrine infusion to prevent spinal-induced hypotension...
August 2018: Medicine (Baltimore)
Amanda L Faulkner, Eric Swanson, Thomas L McLarney, Cortney Y Lee, Annette Rebel
Dexmedetomidine is a selective α2-agonist, frequently used in perioperative medicine as anesthesia adjunct. The medication carries a Food and Drug Administration pregnancy category C designation and is therefore rarely used for parturients undergoing nonobstetric surgery. We are reporting the use of dexmedetomidine in the anesthetic management of a parturient undergoing minimally invasive unilateral adrenalectomy for pheochromocytoma during the second trimester of pregnancy. Additionally, because of the multiple endocrine neoplasia type 2A constellation with diagnosis of medullary thyroid cancer, the patient underwent a total thyroidectomy 1 week after the adrenalectomy...
August 7, 2018: A&A practice
Jing Xu, Junhu Wang, Shuxia Xuan, Guiying Fang, Jinjing Tian, Yucui Teng
Background: To investigate the effects of childbirth age on maternal and infant outcomes in pregnant women. Methods: The clinical data of 4552 singleton parturient women and their newborns treated in the Second People's Hospital of Liaocheng, China from June 2015 to June 2017 were retrospectively analyzed. They were divided into group A (<20 yr old), group B (20-<30 yr old,), group C (30-<35 yr old), group D (35-<40 yr old), group E (≥40 yr old) according to the age of the parturient women...
June 2018: Iranian Journal of Public Health
François-Pierrick Desgranges, Marine Simonin, Sophie Barnoud, Laurent Zieleskiewicz, Eloise Cercueil, Julien Erbacher, Bernard Allaouchiche, Dominique Chassard, Lionel Bouvet
BACKGROUND: Emergent obstetrical procedures may require general anaesthesia in parturients at full cervical dilatation or immediately after vaginal birth. This study aimed to determine the prevalence and the predictive factors of higher estimated gastric content in parturients at full cervical dilatation with epidural analgesia and allowed to drink during the labour, and to assess the ability of the antral area measured in the semirecumbent position (SR-CSA) to identify higher estimated gastric content in this setting...
August 7, 2018: Acta Anaesthesiologica Scandinavica
Fei Xiao, Dan Drzymalski, Lin Liu, Yinfu Zhang, Lizhong Wang, Xinzhong Chen
BACKGROUND AND OBJECTIVES: While prophylactic phenylephrine infusions during cesarean delivery are often used to counteract the sympathectomy associated with spinal anesthesia, their use has been associated with decreased rostral spread of local anesthetic. The purpose of this study was to determine the median effective dose (ED50) and 95% effective dose (ED95) of intrathecal hyperbaric bupivacaine for cesarean delivery in the presence and absence of prophylactic phenylephrine infusion...
July 30, 2018: Regional Anesthesia and Pain Medicine
N Parikh, N Parikh
Headaches are a common symptom during pregnancy. The thunderclap headache is a sudden onset headache reaching maximal intensity within seconds to minutes. It is typically a subarachnoid hemorrhage caused by rupture of an intracranial aneurysm or arteriovenous malformation. Physiologic changes of pregnancy, such as increased cardiac output and plasma volume, may increase the risk of aneurysmal rupture. The relationship between the mode of delivery and incidence of rupture is not well defined. In this case report, we discuss the anesthetic management for cesarean delivery of a parturient with an unruptured aneurysm, located on the left ophthalmic-internal carotid artery...
July 6, 2018: International Journal of Obstetric Anesthesia
Jeffrey W Parker, Paula D James, Susan L Haley
Type 3 von Willebrand disease is a rare and severe inherited bleeding disorder that carries an elevated risk for epidural and spinal hematoma as well as pregnancy-associated complications. Neuraxial anesthesia in these patients is controversial but may be considered if the parturient has received appropriate factor replacement. We present the case of a woman with type 3 von Willebrand disease and a severe bleeding history that underwent successful spinal anesthesia during successive cesarean deliveries. Our case highlights the importance of early multidisciplinary consultation and advance planning in the care of these rare events...
July 25, 2018: A&A practice
Lucia Borsari, Carlotta Malagoli, Martha M Werler, Kenneth J Rothman, Marcella Malavolti, Rossella Rodolfi, Gianfranco De Girolamo, Fausto Nicolini, Marco Vinceti
Smoking and pregestational diabetes (PGD) are recognized risk factors for adverse pregnancy outcomes, but to date, no population-based study has investigated their joint effects. Using hospital discharges, we identified all women with PGD delivering in Emilia-Romagna region during 2007-2010 matched 1 : 5 with parturients without diabetes. Our study endpoints were preterm births and congenital anomalies. We measured interaction between PGD and maternal smoking, by calculating excess prevalence and prevalence ratio due to interaction, relative excess risk due to interaction (RERI), attributable proportion (AP), and the synergy index (S)...
2018: Journal of Diabetes Research
Hana Harazim, Pavel Štourač, Petr Janků, Hana Zelinková, Kamil Frank, Michal Dufek, Petr Štourač
OBJECTIVES: Multiple sclerosis (MS) often occurs in young women and the effect of obstetric anesthesia/analgesia on the disease is poorly understood. No previous study has investigated the course of the disease in women in labor in the Czech Republic. The aim of this study was to evaluate the occurrence or absence of relapses in the 6-month postpartum period in MS parturients with and without obstetric anesthesia/analgesia. MATERIALS AND METHODS: We retrospectively studied all deliveries (n = 58,455) at the University Hospital Brno from 2004 to 2013 and identified those of the women with an ICD-10 code G35 (MS) recorded anytime in their medical history (n = 428)...
July 25, 2018: Brain and Behavior
Giorgio Capogna, Alessandra Coccoluto, Emanuele Capogna, Angelica Del Vecchio
Background: In this study, we describe a custom-made new epidural simulator, created by modifying the inner structure of a commercially available one, in the attempt to make it adequately realistic. To validate and evaluate the realism of our device, we used the Computerized Epidural Instrument CompuFlo. Method: The Compuflo CompuFlo curves obtained from 64 experiments on the epidural simulator were compared to 64 curves obtained from a previous human study, from consecutive laboring parturients requesting epidural analgesia...
2018: Anesthesiology Research and Practice
Michael G Richardson, Britany L Raymond, Curtis L Baysinger, Bradley T Kook, David H Chestnut
BACKGROUND: A vast majority of women who choose nitrous oxide for labor report high satisfaction despite variable analgesic effectiveness. We analyzed comments provided by women who used nitrous oxide for labor, to identify determinants of satisfaction in this population, and to better understand reasons for continuing with nitrous oxide despite variable analgesic effectiveness. METHODS: We conducted qualitative content analysis of comments in a quality improvement database of routine follow-up assessments of women who delivered vaginally, using nitrous oxide as the sole labor analgesic...
July 22, 2018: Birth
H J Lacassie, A Rolle, L I Cortínez, S Solari, M A Corvetto, F R Altermatt
BACKGROUND: Transversus abdominis plane block is increasingly used for post-Caesarean section analgesia. Cases of toxicity and the limited pharmacokinetic information during pregnancy motivated this study. The objective of the study was to characterise and compare the pharmacokinetics of levobupivacaine with epinephrine in tranversus abdominis plane block, in post-Caesarean section patients and healthy volunteers. METHODS: After approval by the Ethics Committee, we collected data from 12 healthy parturients after elective Caesarean section (Study 1) and data from 11 healthy male volunteers from a previous study (Study 2)...
August 2018: British Journal of Anaesthesia
M Anell-Olofsson, S Ahmadi, P A Lönnqvist, S Eksborg, H von Horn, M Bartocci
BACKGROUND: Alpha-1-acid glycoprotein (AAGP) is an acute-phase protein with high affinity for amide local anaesthetics (LAs), and a major determinant of free and potentially toxic concentrations of LAs in plasma. Neonates are known to have lower plasma concentrations of AAGP than adults, and are at risk of developing high free concentrations of LAs. Data regarding AAGP in newborns are so far sparse. The aim of this study was to determine plasma concentrations of AAGP after delivery of preterm and term infants, and to investigate correlations between AAGP and gestational age, birth weight, gender, and mode of delivery...
August 2018: British Journal of Anaesthesia
R Komatsu, B Carvalho, P Flood
BACKGROUND: Prediction models to identify parturients who experience protracted pain, prolonged opioid use, and delayed self-assessed functional recovery are currently inadequate. METHODS: For this study, 213 nulliparous women who planned vaginal delivery were enrolled and assessed daily until they completed three outcomes: (1) pain resolution; (2) opioid cessation; and (3) self-assessed functional recovery to predelivery level. The primary composite endpoint, 'pain and opioid-free functional recovery' was the time required to reach all three endpoints...
August 2018: British Journal of Anaesthesia
Y R Wang, X C Fu, Z Zheng, C C Huang, K M Yuan, Q G Ye, J Li
Objective: To investigate the relationship between intake volume of carbohydrates solution (CHO) and gastric emptying time in termed parturient, thus to optimize fasting time before anesthesia. Methods: This study was a prospective study. From May to July in 2016, a total of 100 termed parturients in Huangyan Hospital of Wenzhou Medical University, were divided into four groups equally by means of random number table: D1 (200 ml), D2 (300 ml), D3 (400 ml) and D4 (500 ml), based on the different intake volume of 12...
July 10, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Kiros Gebremicheal, Fisehaye Alemseged, Haimanot Ewunetu, Daniel Tolossa, Abdibari Ma'alin, Mahlet Yewondwessen, Samuel Melaku
BACKGROUND: In Ethiopia, female genital mutilation (FGM) remains a serious concern and has affected 23.8 million women and girls, with the highest prevalence in Somali regional state. Even though FGM is reported to be associated with a range of obstetric complications, little is known about its effects on childbirth in the region. Therefore, the objective of this study was to test the hypothesis that FGM is a contributing factor to the increased risk of complication during childbirth...
July 20, 2018: BMC Pregnancy and Childbirth
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