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high risk anaesthetic obstetric clinic

Vinod Patil, Gamunu Ratnayake, Galina Fastovets, D S Wijayatilake
PURPOSE OF REVIEW: Abnormal placentation is a clinical condition seen increasingly in the pregnant population. It is associated with significant morbidity and mortality, which may be mitigated through robust multidisciplinary care for these patients. The role of maternal critical care for these patients has largely been ignored in the literature. RECENT FINDINGS: Advances in pharmacological management of bleeding with recent publications of large multicentre trials in addition to new technologies in the management of massive obstetric haemorrhage (MOH) have revolutionized the management of abnormal placentation...
June 2018: Current Opinion in Anaesthesiology
G Justus Hofmeyr, Jon F Barrett, Caroline A Crowther
BACKGROUND: Twin pregnancies are associated with increased perinatal mortality, mainly related to prematurity, but complications during birth may contribute to perinatal loss or morbidity. The option of planned caesarean section to avoid such complications must therefore be considered. On the other hand, randomised trials of other clinical interventions in the birth process to avoid problems related to labour and birth (planned caesarean section for breech, and continuous electronic fetal heart rate monitoring), have shown an unexpected discordance between short-term perinatal morbidity and long-term neurological outcome...
2015: Cochrane Database of Systematic Reviews
J M Afolayan, C E Nwachukwu, E S Esangbedo, P O Omu, F E Amadasun, J O Fadare
BACKGROUND: Eclampsia is still associated with high maternal and perinatal and perinatal morbidity and mortality, especially in resource poor countries with limited access to perinatal and critical care facilities. The ideal method of anaesthesia for caesarean section in eclamptics is not generally agreed upon. METHODS: Review of the patients' case notes as well as records of the institution's Labour Ward Theatre, Intensive Care Unit and Postnatal Ward was carried out between January 2011 and December 2012...
October 2014: Nigerian Journal of Medicine: Journal of the National Association of Resident Doctors of Nigeria
Ban Leong Sng, Wan Ling Leong, Yanzhi Zeng, Fahad Javaid Siddiqui, Pryseley N Assam, Yvonne Lim, Edwin S Y Chan, Alex T Sia
BACKGROUND: Pain during childbirth is arguably the most severe pain some women may experience in their lifetime. Epidural analgesia is an effective form of pain relief during labour. Many women have concerns regarding its safety. Furthermore, epidural services and anaesthetic support may not be available consistently across all centres. Observational data suggest that early initiation of epidural may be associated with an increased risk of caesarean section, but the same findings were not seen in recent randomised controlled trials...
October 9, 2014: Cochrane Database of Systematic Reviews
Sharon R Lewis, Amanda Nicholson, Andrew F Smith, Phil Alderson
BACKGROUND: With increasing demand for surgery, pressure on healthcare providers to reduce costs, and a predicted shortfall in the number of medically qualified anaesthetists it is important to consider whether non-physician anaesthetists (NPAs), who do not have a medical qualification, are able to provide equivalent anaesthetic services to medically qualified anaesthesia providers. OBJECTIVES: To assess the safety and effectiveness of different anaesthetic providers for patients undergoing surgical procedures under general, regional or epidural anaesthesia...
July 11, 2014: Cochrane Database of Systematic Reviews
James Turnbull, Rory Bell
Anaesthetists play a key role in the management of parturients with cardiac disease. Pregnant women with cardiac disease should be seen antenatally in a high-risk obstetric anaesthesia clinic, and a comprehensive management plan formulated. Most women with cardiac disease can have a vaginal delivery, and early epidural analgesia is frequently considered beneficial. No evidence exists to definitively support either regional or general anaesthesia for caesarean section, and much depends on the urgency of the procedure and the severity of disease...
May 2014: Best Practice & Research. Clinical Obstetrics & Gynaecology
L Dubiel, G A Scott, R Agaram, E McGrady, A Duncan, K N Litchfield
Pregnancy in women with achondroplasia presents major challenges for anaesthetists and obstetricians. We report the case of a woman with achondroplasia who underwent general anaesthesia for an elective caesarean section. She was 99cm in height and her condition was further complicated by severe kyphoscoliosis and previous back surgery. She was reviewed in the first trimester at the anaesthetic high-risk clinic. A multidisciplinary team was convened to plan her peripartum care. Because of increasing dyspnoea caesarean section was performed at 32weeks of gestation...
August 2014: International Journal of Obstetric Anesthesia
V A Eley, K Donovan, E Walters, R Brijball, D S Eley
BACKGROUND: Obese parturients are recognised as high risk and an antenatal anaesthetic consultation is recommended. The potential positive and negative effects of this consultation have not been investigated. This prospective observational study aimed to determine if antenatal anaesthetic consultation affects decisional conflict, anxiety scores or risk perception in obese women planning vaginal delivery. METHODS: Eligible women had a body mass index of > or = 35 kg/m2, planning a vaginal delivery, aged > or = 18 years and able to complete a questionnaire presented in English...
May 2014: International Journal of Obstetric Anesthesia
F Ulbrich, H Engelstädter, N Wittau, D Steinmann
Mastocytosis is a rare disorder caused by the proliferation and accumulation of mast cells in various organs. It has a broad variety of clinical manifestations, including cardiovascular collapse. Diverse stimuli trigger the release of vasoactive substances and parturients with systemic mastocytosis are at high risk for precipitating mast cell degranulation. As a result, women with systemic mastocytosis should have an anaesthetic plan for labour and delivery. Anxiety, stress, sleep deprivation, pain and numerous pharmacological agents are all triggers for mast cell degranulation...
July 2013: International Journal of Obstetric Anesthesia
Jose Andres Calvache, Mario F Delgado-Noguera, Emmanuel Lesaffre, Robert J Stolker
BACKGROUND: An incomplete miscarriage occurs when all the products of conception are not expelled through the cervix. Curettage or vacuum aspiration have been used to remove retained tissues. The anaesthetic techniques used to facilitate this procedure have not been systematically evaluated in order to determine which provide better outcomes to the patients. OBJECTIVES: To assess the effects of general anaesthesia, sedation or analgesia, regional or paracervical block anaesthetic techniques, or differing regimens of these, for surgical evacuation of incomplete miscarriage...
April 18, 2012: Cochrane Database of Systematic Reviews
D Schoenbeck, A Nicolle, K Newbegin, J Hanley, A D Loughney
Guidelines for thromboprophylaxis in pregnancy are usually based upon clinical observations and expert opinion. For optimal impact, their use must be attended by consistency in the advice given to women. In this observational study, we evaluated the performance of a scoring system, used as a guide for clinicians administering dalteparin to pregnant women at increased risk of venous thromboembolism. The work included 47 women treated with dalteparin prior to adoption of the scoring system and 58 women treated with dalteparin after its adoption...
2011: Thrombosis
A Aslani, V Husarova, P Ecimovic, J Loughrey, C McCaul
BACKGROUND: Obese parturients are at high risk of complications during anaesthesia and early use of epidural analgesia in labour has been recommended for obese patients during labour. AIM: To assess the outcome of anaesthesia outpatient consultation for obese parturients. METHODS: We retrospectively compared outcomes of obese patients antenatally and an obese and non-obese control group over a 1-year period. Outcomes included potential airway problems, anaesthetic for caesarean section, use and success of epidural analgesia and cervical dilation at epidural placement...
March 2012: Irish Journal of Medical Science
C Arzola, P M Wieczorek
Spinal anaesthesia is the preferred anaesthetic technique for elective Caesarean deliveries. Hypotension is the most common side-effect and has both maternal and neonatal consequences. Different strategies have been attempted to prevent spinal-induced hypotension, including the use of low-dose bupivacaine. We conducted a systematic search for randomized controlled trials comparing the efficacy of spinal bupivacaine in low dose (LD ≤8 mg) with conventional dose (CD >8 mg) for elective Caesarean delivery...
September 2011: British Journal of Anaesthesia
M Vercauteren, P Waets, M Pitkänen, J Förster
Many anaesthetists consider neurological disorders of all kinds as a contraindication for regional anaesthesia particularly for neuraxial techniques. This hesitation is partly rooted in fears of medicolegal problems but also in the heterogeneous literature. Therefore, the present topical review is an attempt to describe the feasibility and the risks of neuraxial techniques in patients with spinal injury, anatomical compromise, chronic back pain or previous spinal interventions, ranging from 'minor' types like epidural blood patches to major surgery such as Harrington fusions...
September 2011: Acta Anaesthesiologica Scandinavica
Rhona Flin, Rona Patey
This article examines the non-technical skills approach to enhancing operational safety, with particular reference to anaesthesia. Training and assessing the non-technical skills of staff in safety-critical occupations is accepted by high-risk industries, most notably aviation, but has only recently been adopted in health care. These authors explain the background to the concept of non-technical skills that was first adopted in relation to the behaviours of airline pilots and could enhance or jeopardise safety...
June 2011: Best Practice & Research. Clinical Anaesthesiology
Elin Bjørnestad, Leiv Arne Rosseland
BACKGROUND: Regional anaesthesia (epidural or spinal anaesthesia) is increasingly used for elective and emergency caesarean sections and is considered to be safer for the mother than general anaesthesia. We present some factors that are important to consider when choosing the anaesthetic method for caesarean section. MATERIAL AND METHODS: The article is based on obstetric anaesthesia textbooks, non-systematic searches in PubMed and own clinical experience. RESULTS: When regional anaesthesia is correctly administrated the foetus/neonate and mother are not much affected, adverse effects are very rare and it is possible to establish contact between the mother and newborn immediately after delivery...
April 8, 2010: Tidsskrift for Den Norske Lægeforening: Tidsskrift for Praktisk Medicin, Ny Række
S Sathiyathasan, K Jeyanthan, G Furtado, R Hamid
Case Report. A 37 years old patient at 40 weeks gestation presented with acute severe hypoxia with a seizure followed by fetal bradycardia. Caesarean section was performed under GA and she was intubated and ventilated. History revealed longstanding right pleural endometriosis with multiple pneumothoraces and hydrothoraces. A CT chest showed extensive bilateral pnenumothoraces. Her clinical condition improved with a left-sided chest drain. Discussion. Severe hypoxia and seizures in a patient with previous history of pnenumothorax are highly suggestive of tension pneumothorax...
2009: Obstetrics and Gynecology International
C B Collier
BACKGROUND: Considerable uncertainty exists regarding accidental injection of local anaesthetic into the 'subdural space' during attempted epidural block. A whole range of clinical findings, from excessively high to failed blocks has been reported although many of these findings appear difficult to explain on the basis of our current knowledge of the anatomy. The existence of another, adjacent space, the intradural space, is postulated. METHODS: Our study of atypical epidural blocks using contrast injection and radiographic screening has now obtained data on 130 patients, and results were reviewed retrospectively, searching for contrast flowing into the subdural region...
April 2010: International Journal of Obstetric Anesthesia
Deirdre J Murphy, Michael Carey, Alan A Montgomery, Sharon R Sheehan
BACKGROUND: Caesarean section is one of the most commonly performed major operations in women throughout the world. Rates are escalating, with studies from the United States of America, the United Kingdom, China and the Republic of Ireland reporting rates between 20% and 25%. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. The value of routine oxytocics in the third stage of vaginal birth has been well established and it has been assumed that these benefits apply to caesarean delivery as well...
2009: BMC Pregnancy and Childbirth
T M Cook, L Bland, R Mihai, S Scott
The distribution of medico-legal claims in English anaesthetic practice is unreported. We studied National Health Service Litigation Authority claims related to anaesthesia since 1995. All claims were reviewed by three clinicians and variously categorised, including by type of incident, claimed outcome and cost. Anaesthesia-related claims account for 2.5% of all claims and 2.4% of the value of all claims. Of 841 relevant claims 366 (44%) were related to regional anaesthesia, 245 (29%) obstetric anaesthesia, 164 (20%) inadequate anaesthesia, 95 (11%) dental damage, 71 (8%) airway (excluding dental damage), 63 (7%) drug related (excluding allergy), 31 (4%) drug allergy related, 31 (4%) positioning, 29 (3%) respiratory, 26 (3%) consent, 21 (2%) central venous cannulation and 18 (2%) peripheral venous cannulation...
July 2009: Anaesthesia
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