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https://www.readbyqxmd.com/read/28212182/what-s-new-in-obstetric-anesthesia-the-2016-gerard-w-ostheimer-lecture
#1
Philip E Hess
This special article presents potentially important trends and issues affecting the field of obstetric anesthesia drawn from publications in 2015. Both maternal mortality and morbidity in the United States have increased in recent years because, in part, of the changing demographics of the childbearing population. Pregnant women are older and have more pre-existing conditions and complex medical histories. Cardiovascular and noncardiovascular medical diseases now account for half of maternal deaths in the United States...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28079556/cardiac-arrest-obstetric-cpr-acls
#2
Benjamin Cobb, Steven Lipman
In contrast with other high-resource countries, maternal mortality has seen an increase in the United States. Caring for pregnant women in cardiac arrest may prove uniquely challenging given the rarity of the event coupled by the physiological changes of pregnancy. Optimization of resuscitative efforts warrants special attention as described in the 2015 American Heart Association's "Scientific Statement on Maternal Cardiac Arrest." Current recommendations address a variety of topics ranging from the basic components of chest compressions and airway management to some of the logistical complexities and operational challenges involved in maternal cardiac arrest...
June 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28045724/out-of-hospital-perimortem-cesarean-delivery-performed-in-a-woman-at-32-weeks-of-gestation-a-case-report
#3
Harald Lenz, Liv Berit Stenseth, Nina Meidell, Hans Julius Heimdal
A 34-year-old pregnant woman experienced cardiac arrest at home. Out-of-hospital perimortem cesarean delivery was performed 27 minutes after the collapse. Both mother and child were resuscitated and had return of spontaneous circulation before they were transported to a university hospital. The mother underwent hysterectomy and developed disseminated intravascular coagulation. Despite intensive treatment, she died 8.5 hours after arrival. The infant was extubated the next day, and her subsequent hospital course was uneventful...
February 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28017511/out-of-hospital-cardiac-arrest-in-pregnancy-with-good-neurological-outcome-for-mother-and-infant
#4
S Pecher, E Williams
Cardiac arrest in pregnancy is rare (about 1:30000 pregnancies) and out-of-hospital cardiac arrests are even less frequent. Resuscitation of the pregnant mother is challenging and requires attention to the altered physiology, specific pathologies and the presence and well-being of the fetus. Once circulation has been restored, the lack of high-grade evidence regarding delivery of the baby and post-resuscitation care makes decision making complex. We present a case of out-of-hospital maternal cardiac arrest with successful resuscitation and good neurological outcome for mother and infant...
February 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/27933173/a-rare-case-of-gestational-thyrotoxicosis-as-a-cause-of-acute-myocardial-infarction
#5
Varalaxmi Bhavani Nannaka, Dmitry Lvovsky
Angina pectoris in pregnancy is unusual and Prinzmetal's angina is much rarer. It accounts for 2% of all cases of angina. It is caused by vasospasm, but the mechanism of spasm is unknown but has been linked with hyperthyroidism in some studies. Patients with thyrotoxicosis-induced acute myocardial infarction are unusual and almost all reported cases have been associated with Graves' disease. Human chorionic gonadotropin hormone-induced hyperthyroidism occurs in about 1.4% of pregnant women, mostly when hCG levels are above 70-80 000 IU/L...
2016: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/27926646/treatment-of-a-pregnant-patient-in-a-persistent-vegetative-state
#6
Matthew P Romagano, William E Scorza, Stephen E Lammers, Carole Dorr, John C Smulian
BACKGROUND: Brain injury leading to a persistent vegetative state during pregnancy involves difficult medical and ethical decisions. CASE: A 21-year-old multigravid woman entered a persistent vegetative state at 20 1/7 weeks of gestation after cardiac arrest with postanoxic brain injury from a suspected drug overdose. The clinical disciplines responsible for her case formed a collaborative care plan involving ventilator, nutrition, and medication support of the mother and regular fetal monitoring and ultrasound testing...
January 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27755068/clinical-practice-guidelines-for-sustained-neuromuscular-blockade-in-the-adult-critically-ill-patient
#7
Michael J Murray, Heidi DeBlock, Brian Erstad, Anthony Gray, Judi Jacobi, Che Jordan, William McGee, Claire McManus, Maureen Meade, Sean Nix, Andrew Patterson, M Karen Sands, Richard Pino, Ann Tescher, Richard Arbour, Bram Rochwerg, Catherine Friederich Murray, Sangeeta Mehta
OBJECTIVE: To update the 2002 version of "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient." DESIGN: A Task Force comprising 17 members of the Society of Critical Medicine with particular expertise in the use of neuromuscular-blocking agents; a Grading of Recommendations Assessment, Development, and Evaluation expert; and a medical writer met via teleconference and three face-to-face meetings and communicated via e-mail to examine the evidence and develop these practice guidelines...
November 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27687318/-hypotension-and-bradycardia-before-spinal-anesthesia
#8
Carlos Javier Shiraishi Zapata
I report a case of hypotension and bradycardia before spinal anesthesia in a pregnant woman with mild to moderate hypertension treated with nifedipine and methyldopa, scheduled for an elective cesarean delivery. She had the history of neurally-mediated syncopes. Two main factors (increased vagal tone and adverse effects of antihypertensive drugs) could explain the hypotension and bradycardia before spinal anesthesia. Monitoring allowed recognizing the problem and corrected it. Thus, it was avoided a disaster in anesthesia, as hemodynamic changes after spinal anesthesia, they would have joined to previous hypotension and bradycardia, which would have caused even a cardiac arrest...
September 26, 2016: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/27650864/pre-hospital-assessment-of-the-role-of-adrenaline-measuring-the-effectiveness-of-drug-administration-in-cardiac-arrest-paramedic-2-trial-protocol
#9
Gavin D Perkins, Tom Quinn, Charles D Deakin, Jerry P Nolan, Ranjit Lall, Anne-Marie Slowther, Matthew Cooke, Sarah E Lamb, Stavros Petrou, Felix Achana, Judith Finn, Ian G Jacobs, Andrew Carson, Mike Smyth, Kyee Han, Sonia Byers, Nigel Rees, Richard Whitfield, Fionna Moore, Rachael Fothergill, Nigel Stallard, John Long, Susie Hennings, Jessica Horton, Charlotte Kaye, Simon Gates
Despite its use since the 1960s, the safety or effectiveness of adrenaline as a treatment for cardiac arrest has never been comprehensively evaluated in a clinical trial. Although most studies have found that adrenaline increases the chance of return of spontaneous circulation for short periods, many studies found harmful effects on the brain and raise concern that adrenaline may reduce overall survival and/or good neurological outcome. The PARAMEDIC-2 trial seeks to determine if adrenaline is safe and effective in out-of-hospital cardiac arrest...
November 2016: Resuscitation
https://www.readbyqxmd.com/read/27607862/maternal-death-due-to-clostridium-novyi-in-an-injection-drug-user
#10
Christina Herrera, Ryan Meehan, Varsha Podduturi, Alexander L Eastman, David B Nelson
BACKGROUND: Soft-tissue infections in women with subcutaneous injection drug use are often polymicrobial. CASE: A 21-year-old nulliparous woman presented at 14-15 weeks of gestation with several gluteal abscesses related to subcutaneous injection of heroin. She was well appearing, afebrile, and without findings of systemic illness. After empiric broad-spectrum intravenous antibiotics, same-day incision and drainage was performed. Immediately after the procedure, she developed refractory hypotension, severe tachycardia, pulmonary edema, and leukemoid reaction (white blood cell count 80×10/L)...
October 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27393077/cardiovascular-emergencies-and-cardiac-arrest-in-a-pregnant-woman
#11
REVIEW
Anne-Sophie Ducloy-Bouthors, Max Gonzalez-Estevez, Benjamin Constans, Alexandre Turbelin, Catherine Barre-Drouard
No abstract text is available yet for this article.
October 2016: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/27386763/intensive-care-and-pregnancy-epidemiology-and-general-principles-of-management-of-obstetrics-icu-patients-during-pregnancy
#12
REVIEW
Laurent Zieleskiewicz, Anne Chantry, Gary Duclos, Aurelie Bourgoin, Alexandre Mignon, Catherine Deneux-Tharaux, Marc Leone
In developed countries, the rate of obstetric ICU admissions (admission during pregnancy or the postpartum period) is between 0.5 and 4 per 1000 deliveries and the overall case-fatality rate is about 2%. The most two common causes of obstetric ICU admissions concerned direct obstetric pathologies: obstetric hemorrhage and hypertensive disorders of pregnancy. This review summarized the principles of management of critically ill pregnant patient. Its imply taking care of two patients in the same time. A coordinated multidisciplinary team including intensivists, anesthesiologists, obstetricians, pediatricians and pharmacists is therefore necessary...
October 2016: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/27372376/care-of-the-critically-ill-pregnant-patient-and-perimortem-cesarean-delivery-in-the-emergency-department
#13
Megan E Healy, Dana E Kozubal, Amanda E Horn, Gary M Vilke, Theodore C Chan, Jacob W Ufberg
BACKGROUND: Maternal resuscitation in the emergency department requires planning and special consideration of the physiologic changes of pregnancy. Perimortem cesarean delivery (PMCD) is a rare but potentially life-saving procedure for both mother and fetus. Emergency physicians should be aware of the procedure's indications and steps because it needs to be performed rapidly for the best possible outcomes. OBJECTIVE: We sought to review the approach to the critically ill pregnant patient in light of new expert guidelines, including indications for PMCD and procedural techniques...
August 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27211568/maternal-collapse-challenging-the-four-minute-rule
#14
REVIEW
M D Benson, A Padovano, G Bourjeily, Y Zhou
INTRODUCTION: The current approach to, cardiopulmonary resuscitation of pregnant women in the third trimester has been to adhere to the "four-minute rule": If pulses have not returned within 4min of the start of resuscitation, perform a cesarean birth so that birth occurs in the next minute. This investigation sought to re-examine the evidence for the four-minute rule. METHODS: A literature review focused on perimortem cesarean birth was performed using the same key words that were used in formulating the "four-minute rule...
April 2016: EBioMedicine
https://www.readbyqxmd.com/read/27145018/anti-hi-can-cause-a-severe-delayed-hemolytic-transfusion-reaction-with-hyperhemolysis-in-sickle-cell-disease-patients
#15
Clara Ibanez, Anoosha Habibi, Armand Mekontso-Dessap, Philippe Chadebech, Btissam Chami, Philippe Bierling, Frédéric Galactéros, Claire Rieux, Joëlle Nataf, Pablo Bartolucci, Thierry Peyrard, France Pirenne
BACKGROUND: Delayed hemolytic transfusion reaction (DHTR) is a life-threatening condition in sickle cell disease (SCD) patients that is frequently complicated by hyperhemolysis. Antibodies resulting from antigen disparity between donors of European ancestry and patients of African ancestry are common, but situations involving antibodies not classically of clinical significance are also encountered. Anti-HI is generally considered to be an innocuous naturally occurring antibody. STUDY DESIGN AND METHODS: We describe two cases of hyperhemolysis with anti-HI and provide details of the reported cases...
July 2016: Transfusion
https://www.readbyqxmd.com/read/27103543/perimortem-caesarean-deliveries
#16
REVIEW
A J Eldridge, R Ford
Although cardiac arrest in pregnancy is rare, it is important that all individuals involved in the acute care of pregnant women are suitably trained, because the outcome for both mother and fetus can be affected by the management of the arrest. Perimortem caesarean delivery was first described in 715 BC. Initially the procedure was performed principally for religious or political reasons. Although the potential for fetal survival was proposed, it was rarely successful, probably because the delivery was delayed until maternal death was established...
August 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/26995947/-placenta-percreta-a-severe-obstetric-complication-despite-correct-diagnosis-a-case-report
#17
Karolina Gruca-Stryjak, Mariola Ropacka-Lesiak, Grzegorz Breborowicz
This paper presents a case of a pregnant woman with a history of two cesarean sections. The patient was admitted to the hospital because of vaginal bleeding. The ultrasound revealed a placenta covering the internal os. The placenta was characterized by heterogeneous echogenicity with visible irregular hypoechogenic areas and blurred border between the placenta and the cervix. Rich vascularity was observed on the border of the placenta, urethra and the urinary bladder. Cystoscopy showed severe congestion around the urethra...
December 2015: Ginekologia Polska
https://www.readbyqxmd.com/read/26957705/case-report-on-effective-cardiopulmonary-resuscitation-in-a-pregnant-woman
#18
Radhe Sharan, Anita Madan, Vega Makkar, Joginder Pal Attri
The management of cardiac arrest in pregnancy is an important task for the emergency physicians. Some reasons for cardiac arrest are reversible and should be recognized and managed promptly. Cardiopulmonary resuscitation follows general advanced cardiac life support guidelines with several modifications for pregnant women, taking into account the lives of both mother and fetus. Here, we present the case of 23-year-old pregnant patient who came to Guru Nanak Dev Hospital, Amritsar; in shock, had a cardiac arrest, successfully resuscitated in Intensive Care Unit (ICU), delivered by emergency cesarean section and was discharged from ICU on 9(th) day in healthy state...
January 2016: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/26908002/dispatcher-assisted-compression-only-cardiopulmonary-resuscitation-provides-best-quality-cardiopulmonary-resuscitation-by-laypersons-a-randomised-controlled-single-blinded-manikin-trial
#19
Oliver Spelten, Tobias Warnecke, Wolfgang A Wetsch, Robert Schier, Bernd W Böttiger, Jochen Hinkelbein
BACKGROUND: High-quality cardiopulmonary resuscitation (CPR) by laypersons is a key determinant of both outcome and survival for out-of-hospital cardiac arrest. Dispatcher-assisted CPR (telephone-CPR, T-CPR) increases the frequency and correctness of bystander-CPR but results in prolonged time to first chest compressions. However, it remains unclear whether instructions for rescue ventilation and/or chest compressions should be recommended for dispatcher-assisted CPR. OBJECTIVE: The aim of this study was to evaluate both principles of T-CPR with respect to CPR quality...
August 2016: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/26761124/propofol-administration-to-the-fetal-maternal-unit-reduces-cardiac-oxidative-stress-in-preterm-lambs-subjected-to-prenatal-asphyxia-and-cardiac-arrest
#20
Matthias Seehase, Patrick Houthuizen, Jennifer J P Collins, Luc J Zimmermann, Boris W Kramer
BACKGROUND: Little is known about the effects of propofol on oxidative stress and its effect on key structures of the contractile apparatus as the myosin light chain 2 (MLC2) and the p38MAPK survival pathway in the preterm heart. We hypothesized that propofol administration could attenuate the hypoxic myocardial injury after birth asphyxia. METHODS: Pregnant ewes were randomized to receive either propofol or isoflurane anesthesia. A total of 44 late-preterm lambs were subjected to in utero umbilical cord occlusion (UCO), resulting in asphyxia and cardiac arrest, or sham treatment...
May 2016: Pediatric Research
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