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Pregnancy and anesthesia

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https://www.readbyqxmd.com/read/30112237/management-of-pregnancy-with-klippel-trenaunay-weber-syndrome-a-case-report-and-review
#1
Rati Chadha
Background: Klippel-Trenaunay-Weber syndrome is a rare neurocutaneous syndrome with vascular involvement. Given the rarity of the syndrome, its management in pregnancy is based on the outcome of a few case reports and expert opinion. Case Summary: The management of a complicated case with its antepartum, intrapartum, and postpartum concerns has been addressed in this review. Conclusions: Prenatal consults with anesthesia, general surgery, intervention radiology, and internal medicine should be arranged, prior to delivery in anticipation of all the possible complications...
2018: Case Reports in Obstetrics and Gynecology
https://www.readbyqxmd.com/read/30095445/use-of-dexmedetomidine-in-a-parturient-with-multiple-endocrine-neoplasia-type-2a-undergoing-adrenalectomy-and-thyroidectomy-a-case-report
#2
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
https://www.readbyqxmd.com/read/30057932/development-of-a-multiple-choice-test-for-novice-anesthesia-residents-to-evaluate-knowledge-related-to-management-of-general-anesthesia-for-urgent-cesarean-delivery
#3
Allison J Lee, Stephanie R Goodman, Shawn E Banks, Meiko Lin, Ruth Landau
Background: Teaching trainees the knowledge and skills to perform general anesthesia (GA) for cesarean delivery (CD) requires innovative strategies, as they may never manage such cases in training. We used a multistage design process to create a criterion-referenced multiple-choice test as an assessment tool to evaluate CA1's knowledge related to this scenario. Methods: Three faculty created 33 questions, categorized as: (1) physiologic changes of pregnancy (PCP), (2) pharmacology (PHA), (3) anesthetic implications of pregnancy (AIP), and (4) crisis resource management principles (CRM)...
April 2018: Journal of Education in Perioperative Medicine: JEPM
https://www.readbyqxmd.com/read/30057147/management-of-anesthesia-for-cesarean-delivery-in-a-patient-with-an-unruptured-intracranial-aneurysm
#4
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
https://www.readbyqxmd.com/read/30052531/spinal-anesthesia-in-2-consecutive-cesarean-deliveries-in-a-parturient-with-type-3-von-willebrand-disease-a-case-report
#5
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
https://www.readbyqxmd.com/read/30039233/management-of-venous-thromboembolism-in-pregnancy
#6
REVIEW
Annemarie E Fogerty
PURPOSE OF REVIEW: This manuscript addresses the risks for venous thromboembolism (VTE) during pregnancy and the associated challenges of both diagnosis and treatment. RECENT FINDINGS: The obstacles to diagnosis given lack of specificity of typical biomarkers to predict VTE in pregnancy, as well as the unique fetal and bleeding risks introduced by managing massive pulmonary embolism (PE) with thrombolytics or thrombectomy are highlighted. VTE during pregnancy and the postpartum window occurs at a 6-10-fold higher rate compared with age-matched peers and is a major cause of morbidity and mortality...
July 23, 2018: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/30023142/pregnancy-and-breastfeeding-during-intrathecal-baclofen-therapy-a-case-study-and-review
#7
Takeshi Hara, Madoka Nakajima, Hidenori Sugano, Kostadin Karagiozov, Emiko Hirose, Keiko Goto, Hajime Arai
We report the case of a young woman who received intrathecal baclofen therapy (ITB) and subsequently became pregnant and had a normal delivery. A 28-year-old woman with flexion myelopathy had anterior decompression with fusion at C4/5 and C5/6 levels. Clinical symptoms improved after surgery. However, when she was 29 years old, her symptoms steadily advanced to Modified Ashworth Scale 3 spasticity level in the lower legs, with pain in both of them and urinary retention tendency. Since a 25 μg intrathecal baclofen injection improved her symptoms, an ITB pump system was implanted...
July 2018: NMC Case Report Journal
https://www.readbyqxmd.com/read/30019160/anesthetic-treatment-of-cardiac-disease-during-pregnancy
#8
REVIEW
Kate M Cohen, Rebecca D Minehart, Lisa R Leffert
PURPOSE OF REVIEW: This review summarizes the pathophysiology, peripartum treatment, and anesthetic management of parturients with cardiac disease. Valvular disease, coronary disease, and cardiomyopathy are specifically addressed in the context of the normal physiologic changes of pregnancy. We offer recommendations for anesthetic approaches, hemodynamic goals with an emphasis on interdisciplinary planning between anesthesiologists, cardiologists, cardiothoracic surgeons, obstetricians, maternal fetal medicine specialists, and neonatologists...
July 18, 2018: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29996217/-experimental-study-on-dehp-affect-the-neurodevelopment-through-interfering-with-placental-thyroid-hormones-transport
#9
B B Luo, Q W Feng, D J Wu, Q N Wang
Objective: The present study was represented by di-(2-ethylhexyl) phthalate (DEHP), to explore the role of thyroid hormones (THs) disruption in the connection of placenta and neurodevelopmental toxicity. Methods: During fetal mice neural tube closed (pregnancy 9.5 days, E9.5d) to begin synthesis of THs (E15.5 d), all pregnant mice were administered with different concentration of DEHP (0、10、50、200 mg/kg) by gavage once a day(10 mice per group). All pregnant mice were conducted with BrdU administration in E14d by subcutaneous injection...
March 20, 2018: Chinese Journal of Industrial Hygiene and Occupational Diseases
https://www.readbyqxmd.com/read/29988651/pregnancies-complicated-by-maternal-osteogenesis-imperfecta-type-iii-a-case-report-and-review-of-literature
#10
Tetsuya Kawakita, Melissa Fries, Jasbir Singh, Huda B Al-Kouatly
The restrictive lung disease can be exacerbated by growing fundus in women with osteogenesis imperfecta type III. Regional anesthesia can be performed in these women. Mode of delivery for women with osteogenesis imperfecta type III is generally cesarean delivery. Neonatal outcomes are complicated due to indicated preterm deliveries.
July 2018: Clinical Case Reports
https://www.readbyqxmd.com/read/29970957/sevoflurane-anesthesia-during-pregnancy-in-mice-induces-hearing-impairment-in-the-offspring
#11
Xia Shen, Yanan Xiao, Wen Li, Kaizheng Chen, Huiqian Yu
Introduction: Exposure to gamma-aminobutyric acid-mimetics and N-methyl-D-aspartate-receptor antagonists during pregnancy may lead to hearing loss and long-term behavioral abnormalities in the offspring. The purpose of this study was to explore the association between prenatal exposure to sevoflurane (SEV) anesthesia and hearing impairment in mice. Materials and methods: On gestational day 15, pregnant Kunming mice were exposed for 2 hours to 2.5% SEV plus 100% oxygen (anesthesia group) or 100% oxygen alone (control group)...
2018: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/29970622/psychotic-due-to-bath-salts-and-methamphetamines-emergency-cesarean-section-under-general-anesthesia
#12
Nina Schloemerkemper
The use of "bath salts" or other new psychoactive substances, otherwise known as "legal highs", is increasing. Illicit drug use during pregnancy is not uncommon. Nevertheless, literature reporting bath salts and their effect on pregnancy is scant. Besides, there seems to be no literature about bath salts and conduct of general anesthesia. This case report describes a general anesthetic for the surgical delivery of an infant to a woman under the acute influence of bath salts and methamphetamines...
July 23, 2018: Journal of Biomedical Research
https://www.readbyqxmd.com/read/29963326/surgical-removal-of-an-arteriovenous-malformation-in-the-anterior-perforated-substance-in-a-pregnant-woman
#13
Daisuke Wakui, Hidemichi Ito, Hiroshi Takasuna, Hidetaka Onodera, Kotaro Oshio, Yuichiro Tanaka
Background: A tailor-made treatment is often required in arteriovenous malformations (AVMs) depending on the individual situation. In most cases, treatment strategy is usually determined according to the patient's Spetzler-Martin grade. However, in the present case, we were not able to treat the patient following the usual guidelines because of neurological symptoms and pregnancy. Case Description: We describe a rare case of a 31-year-old woman in the 15th week of gestation who presented with an AVM in the anterior perforated substance (APS)...
2018: Surgical Neurology International
https://www.readbyqxmd.com/read/29942337/unusual-management-of-parturient-patient-with-severe-bicuspid-aortic-valve-stenosis-and-congestive-heart-failure
#14
Mahdi Kahrom, Mostafa Ahmadi, Behrooz Mottahedi, Masoomeh Tabari, Atieh Vatanchi, Naser Paravi, Hamid Ghaderi
BACKGROUND: Critical aortic stenosis (AS) is an unusual cardiac pathology in pregnancy, but has significant impact on the fetal and maternal outcomes of pregnancy. Pregnant patients with aortic stenosis and heart failure represent a major challenge for the heart team and anesthesiologist who should balance the risks and benefits of different treatment strategies and their effects on the mother and fetus. CASE REPORT: We present a 26-year-old parturient who underwent cesarean section at 30 weeks of gestation under general anesthesia in the presence of cardiac surgical team followed by deferred aortic valve replacement after two weeks...
January 2018: ARYA Atherosclerosis
https://www.readbyqxmd.com/read/29939939/acog-practice-bulletin-no-197-inherited-thrombophilias-in-pregnancy
#15
(no author information available yet)
Inherited thrombophilias are associated with an increased risk of venous thromboembolism and have been linked to adverse outcomes in pregnancy. However, there is limited evidence to guide screening for and management of these conditions in pregnancy. The purpose of this document is to review common thrombophilias and their association with maternal venous thromboembolism risk and adverse pregnancy outcomes, indications for screening to detect these conditions, and management options in pregnancy. This Practice Bulletin has been revised to provide additional information on recommendations for candidates for thrombophilia evaluation, updated consensus guidelines regarding the need for prophylaxis in women with an inherited thrombophilia during pregnancy and the postpartum period, and discussion of new published consensus guidelines from the Society for Obstetric Anesthesia and Perinatology addressing thromboprophylaxis and neuraxial anesthetic considerations in the obstetric population...
July 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29939934/acog-practice-bulletin-no-197-summary-inherited-thrombophilias-in-pregnancy
#16
(no author information available yet)
Inherited thrombophilias are associated with an increased risk of venous thromboembolism and have been linked to adverse outcomes in pregnancy. However, there is limited evidence to guide screening for and management of these conditions in pregnancy. The purpose of this document is to review common thrombophilias and their association with maternal venous thromboembolism risk and adverse pregnancy outcomes, indications for screening to detect these conditions, and management options in pregnancy. This Practice Bulletin has been revised to provide additional information on recommendations for candidates for thrombophilia evaluation, updated consensus guidelines regarding the need for prophylaxis in women with an inherited thrombophilia during pregnancy and the postpartum period, and discussion of new published consensus guidelines from the Society for Obstetric Anesthesia and Perinatology addressing thromboprophylaxis and neuraxial anesthetic considerations in the obstetric population...
July 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29939847/maternal-body-mass-index-and-use-of-labor-neuraxial-analgesia-a-population-based-retrospective-cohort-study
#17
Alexander J Butwick, Cynthia A Wong, Nan Guo
BACKGROUND: Neuraxial labor analgesia may benefit obese women by optimizing cardiorespiratory function and mitigating complications related to emergency general anesthesia. We hypothesized that obese women have a higher rate of neuraxial analgesia compared with nonobese parturients. METHODS: Using U.S. natality data, our cohort comprised 17,220,680 deliveries, which accounts for 61.5% of 28 million births in the United States between 2009 and 2015. We examined the relationships between body mass index class and neuraxial labor analgesia, adjusting for sociodemographic, antenatal, pregnancy, and peripartum factors...
June 25, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29927633/imaging-findings-in-essure-related-complications-a-pictorial-review
#18
Hachem Djeffal, Marie Blouet, Anne-Cécile Pizzoferato, Delphine Vardon, Frederique Belloy, Jean-Pierre Pelage
Tubal sterilization with Essure inserts has become a prevalent alternative to laparoscopic sterilization because of its minimal invasiveness. It is a well-tolerated ambulatory procedure that provides reliable permanent contraception without the risks associated with laparoscopic surgery and general anesthesia. Correct positioning of the Essure device is necessary to achieve the fibrotic reaction induced by the polyethylene terephthalate fibers, subsequently resulting in tubal occlusion usually within 3 months...
July 13, 2018: British Journal of Radiology
https://www.readbyqxmd.com/read/29923127/pregnancy-associated-myocardial-infarction
#19
REVIEW
Michael C Honigberg, Nandita S Scott
PURPOSE OF REVIEW: To educate clinicians about the epidemiology, etiologies, diagnosis, and management of pregnancy-associated myocardial infarction (PAMI). RECENT FINDINGS: The risk of myocardial infarction is increased more than threefold around the time of pregnancy. In the recent series, PAMI is most commonly caused by spontaneous coronary artery dissection, followed by atherosclerosis. Percutaneous coronary intervention or coronary artery bypass grafting may be required, but conservative management with medical therapy is generally advised when possible, particularly in cases of coronary dissection...
June 19, 2018: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29898711/maternal-cardiovascular-hemodynamics-in-normotensive-versus-preeclamptic-pregnancies-a-prospective-longitudinal-study-using-a-noninvasive-cardiac-system-nicas%C3%A2
#20
Anat Lavie, Maya Ram, Shaul Lev, Yair Blecher, Uri Amikam, Yael Shulman, Tomer Avnon, Eran Weiner, Ariel Many
BACKGROUND: Preeclampsia is among the most common medical complications of pregnancy. The clinical utility of invasive hemodynamic monitoring in preeclampsia (e.g., Swan-Ganz catheter) is controversial. Thoracic impedance cardiography (TIC) and Doppler echocardiography are noninvasive techniques but they both have important limitations. NICaS™ (NI Medical, PetachTikva, Israel) is a noninvasive cardiac system for determining cardiac output (CO) that utilizes regional impedance cardiography (RIC) by noninvasively measuring the impedance signal in the periphery...
June 14, 2018: BMC Pregnancy and Childbirth
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