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pregnancy anesthesia

Efrain Riveros-Perez, Amy C Hermesch, Linda A Barbour, Joy L Hawkins
Aplastic anemia is a hematologic condition occasionally presenting during pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management is challenging, and treatment requires a coordinated effort by an interdisciplinary team, in order to provide safe care to these patients. In this review, we describe the current state of the literature as it applies to the complexity of aplastic anemia in pregnancy, focusing on pathophysiologic aspects of the disease in pregnancy, as well as relevant obstetric and anesthetic considerations necessary to treat this challenging problem...
2018: International Journal of Women's Health
Solina Tith, Garinder Bining, Laurent Bollag
Background : Opioid use during pregnancy is a growing concern in the United States. Buprenorphine has been recommended by "The American College of Obstetrics and Gynecology" as an alternative to methadone to decrease risks associated with the use of illicit opioids during pregnancy. The partial μ-opioid agonists' unique pharmacology, including its long half time and high affinity to the μ-opioid receptor, complicates patient management in a highly kinetic, and often urgent field like obstetric anesthesia...
2018: F1000Research
Jinglan Zhang, Jiakai Lu, Xiaorui Zhou, Xuefeng Xu, Qing Ye, Qitan Ou, Yanna Li, Jiapeng Huang
OBJECTIVES: The mortality of pregnant women with idiopathic pulmonary arterial hypertension (PAH) is very high. There are limited data on the management of idiopathic PAH during pregnancy. The authors aimed to examine systematically the characteristics of parturient women with idiopathic PAH, to explore the adverse effects of idiopathic PAH on pregnancy outcomes, and to report the multidisciplinary perioperative management strategy from the largest comprehensive cardiac hospital in China...
March 7, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Clara Elisa Frare de Avelar Teixeira, Angélica de Fátima de Assunção Braga, Franklin Sarmento da Silva Braga, Vanessa Henriques Carvalho, Rafael Miranda da Costa, Giselle Ioná Teixeira Brighenti
INTRODUCTION: Klippel-Trenaunay syndrome is a rare congenital vascular disease characterized by cutaneous hemangiomas, varicosities, and limb asymmetry, which may evolve with coagulation disorders and hemorrhage as more frequent complications in pregnant patients. Pregnancy is not advised in women with this syndrome due to increased obstetric risk. CASE REPORT: Female patient, 29 years old, 99kg, 167cm, BMI 35.4kg.m-2 , physical status ASA III, with 27 weeks of gestational age and diagnosis of Klippel-Trenaunay syndrome...
March 2, 2018: Revista Brasileira de Anestesiologia
Murat Şakir Ekşi, Ahmet Öğrenci, Osman Ersegun Batçık, Orkun Koban
De novo obstructive hydrocephalus is a rare event during pregnancy. There are only case reports presented in literature. We aimed to discuss the pathophysiological basis and management options with an exemplary case presentation and review of the current literature. A 28-year-old G2P1 patient presented to our clinic with headache, vomiting, and deteriorated vision at the 8th week of gestation. She had no history of central nervous system infection or trauma. A brain magnetic resonance imaging was obtained. There was hydrocephalus due to cerebral aqueduct stenosis (Evan's index of 58%)...
January 2018: Asian Journal of Neurosurgery
Salvatore Butticè, Antonio Simone Laganà, Salvatore Giovanni Vitale, Christopher Netsch, Yiloren Tanidir, Francesco Cantiello, Laurian Dragos, Michele Talso, Esteban Emiliani, Rosa Pappalardo, Tarik Emre Sener
OBJECTIVE: Clinical presentation of ureteral stones during pregnancy is generally with renal colic pain. The aim of this study is to present our experience in the management of renal colic during pregnancy in emergency settings. MATERIALS AND METHODS: 208 pregnant patients who presented to emergency department with renal colic pain and underwent ureteroscopy (URS) due to failed conservative therapy were enrolled in the study. Urinary tract stones were diagnosed either with ultrasound (US) examination or during URS...
December 31, 2017: Archivio Italiano di Urologia, Andrologia
Viktor Zsolt Kovari, Laszlo Horvath
PURPOSE: This article presents a surgical solution of a lumbar disc hernia of a pregnant woman focusing on the use of right lateral positioning, spinal anesthesia which has not previously been utilized in third trimester and discusses positioning options, and possible anesthesia methods with the surgical procedure options. METHODS: Case report. RESULTS: A left-sided L5/S1 lumbar disc hernia (verified by magnetic resonance imaging) of a 35-year-old, 32-week-pregnant woman with a deteriorating neurological status leading to cauda syndrome was treated successfully by microdiscectomy in right lateral position applying spinal anesthesia...
February 22, 2018: European Spine Journal
Mohamed Mohamed Tawfik, Amany Ismail Tarbay, Ahmed Mohamed Elaidy, Karim Ali Awad, Hanaa Mohamed Ezz, Mohamed Ahmed Tolba
BACKGROUND: The optimal strategy of fluid administration during spinal anesthesia for cesarean delivery is still unclear. Ultrasonography of the inferior vena cava (IVC) has been recently used to assess the volume status and predict fluid responsiveness. In this double-blind, randomized controlled study, we compared maternal hemodynamics using a combination of 500-mL colloid preload and 500-mL crystalloid coload versus 1000-mL crystalloid coload. We assessed the IVC at baseline and at subsequent time points after spinal anesthesia...
February 14, 2018: Anesthesia and Analgesia
Yutaka Oda, Michie Fujita, Chika Motohisa, Shinichi Nakata, Motoko Shimada, Ryushi Komatsu
Background: Ovarian vein thrombosis is a rare complication of pregnancy. The representative complaints of patients with ovarian vein thrombosis are abdominal pain and fever. In some cases, however, fatal pulmonary embolism may develop. We report a case of pulmonary embolism presenting with severe hypotension and loss of consciousness during cesarean section possibly caused by ovarian vein thrombosis. Case presentation: A 25-year-old woman at 38 weeks 4 days of gestation was scheduled for repeat cesarean section...
2018: JA Clin Rep
Hirad Hedayat, Daniel R Felbaum, John E Reynolds, Rashid M Janjua
Neurosurgical pathologies presenting during pregnancy are uncommon. If present, the situation creates a unique diagnostic, observational, and therapeutic challenge as both lives are placed at potential risk. Surgical procedures during pregnancy are approached carefully as physiological stressors associated with surgery and anesthesia may cause fetal or maternal compromise. We present the only known case of a pseudoaneurysm treated with an awake craniotomy, allowing us to abate the risks associated with general anesthesia in pregnancy...
December 7, 2017: Curēus
Xinran Li, Yanan Li, Jinghua Zhao, Lina Li, Yuxin Wang, Yiming Zhang, Yue Li, Yu Chen, Wenhan Liu, Li Gao
Drug abuse during pregnancy is a serious problem. Like alcohol, anticonvulsants, sedatives, and anesthetics, such as ketamine, can pass through the placental barrier and affect the growing fetus. However, the mechanism by which ketamine causes damage to fetal rats is not well understood. Therefore, in this study, we anesthetized pregnant rats with ketamine and evaluated the Total Antioxidant Capacity (T-AOC), Reactive Oxygen Species (ROS), and Malondialdehyde (MDA). Moreover, we determined changes in the levels of Cleaved-Caspase-3 (C-Caspase-3), Beclin-1, B-cell lymphoma-2 (Bcl-2), Bcl-2 Associated X Protein (Bax), Autophagy-related gene 4 (Atg4), Atg5, p62 (SQSTM1), and marker of autophagy Light Chain 3 (LC3)...
2018: Frontiers in Cellular Neuroscience
Christopher J Pannucci, Kory I Fleming
OBJECTIVE: Perioperative venous thromboembolism (VTE) risk can be quantified with the 2005 Caprini score. The Caprini score has previously been validated by review of the electronic medical record (EMR) in >3000 plastic surgery patients. However, the accuracy of Caprini-based risk stratification using the EMR, as opposed to face-to-face contact with the patient, remains unknown. METHODS: Plastic and reconstructive surgery patients who had surgery under general anesthesia, required postoperative admission, and were started on enoxaparin prophylaxis were identified...
February 13, 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Christine Demers, Christine Derzko, Michele David, Joanne Douglas
OBJECTIVE: The prevalence of bleeding disorders, notably von Willebrand disease (vWD), among adult women with objectively documented menorrhagia is consistently reported to be 10% to 20% and is even higher in adolescents presenting with menorrhagia. OPTIONS: Diagnostic tools and specific medical and, where appropriate, surgical alternatives to management are reviewed and evidence-based recommendations presented. EVIDENCE: A MEDLINE search of the English literature between January 1975 and November 2003 was performed using the following key words: menorrhagia, uterine bleeding, pregnancy, von Willebrand, congenital bleeding disorder, desmopressin/DDAVP, tranexamic acid, oral contraceptives, medroxyprogesterone, therapy, hysterectomy, anesthesia, epidural, spinal...
February 2018: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Jin Wang, Qian Liu, Xun Wang, Rijian Guan, Sen Li, Youpeng Zhang, Yongbiao Cheng, Hanqing Zeng, Yong Tang, Zhaohui Zhu
Varicocele is a common abnormality, but the conventional microsurgical subinguinal varicocelectomy (CMSV) has some disadvantages. We invented Modified Inguinal Microscope-Assisted Varicocelectomy (MIMV) under local anesthesia. This study aims to evaluate MIMV by comparing it to CMSV in operating duration, time to return to normal activity, postoperative complications, achievement of natural pregnancy and improvement of semen quality for patients with infertility, pain score for those with scrotal pain, and so on...
February 12, 2018: Scientific Reports
Farid Rashidi, Hossein Sate
BACKGROUND: Idiopathic pulmonary arterial hypertension is a rare and progressive condition which is aggravated by the physiologic changes during pregnancy. Because of high mortality rate, most physicians recommend early termination of pregnancy in patients with idiopathic pulmonary arterial hypertension. CASE PRESENTATION: Here we describe a case of a 30-year-old primigravida Caucasian housewife with functional class 1 idiopathic pulmonary arterial hypertension and a positive vasoreactive response to adenosine who had a full-term non-complicated delivery...
February 13, 2018: Journal of Medical Case Reports
Nur Betül Tekiner, Berna Aslan Çetin, Lale Susan Türkgeldi, Gökçe Yılmaz, İbrahim Polat, Ali Gedikbaşı
BACKGROUND: We aimed to determine if there is a difference in the size of the cesarean scar defect using saline infusion sonography (SIS) performed on the postoperative third month in patients who underwent single- or double-layered unlocked closure of their uterine incision during their first cesarean delivery. METHODS: This study was conducted as a prospective cross-sectional study between February 2015 and January 2016 in patients admitted to the labour ward of the Kanuni Sultan Suleyman Training and Research Hospital who subsequently underwent their first delivery by cesarean section...
February 3, 2018: Archives of Gynecology and Obstetrics
Hong Zeng, Zhengqian Li, Xiaoqing Zhang, Ning Wang, Yang Tian, Jun Wang
RATIONALE: Primary hyperparathyroidism (PHPT) during pregnancy is rare. Nevertheless, hypercalcemia secondary to gestational PHPT may be masked by physiological changes in calcium homeostasis during pregnancy. Gestational PHPT constitutes a serious danger to mother and fetus. Surgery is the only curative treatment when conservative treatment could not control the condition. Due to the lack of guidelines concerning PHPT during pregnancy, the optimal anesthetic management of PHPT during pregnancy needs to be individualized...
December 2017: Medicine (Baltimore)
Nicole S Carlson, Elizabeth J Corwin, Teri L Hernandez, Elizabeth Holt, Nancy K Lowe, K Joseph Hurt
BACKGROUND: Term nulliparous women have the greatest variation across hospitals and providers in cesarean rates and therefore present an opportunity to improve quality through optimal care. We evaluated associations between provider type and mode of birth, including examination of intrapartum management in healthy, laboring nulliparous women. METHODS: Retrospective cohort study using prospectively collected perinatal data from a United States academic medical center (2005-2012)...
January 31, 2018: Birth
F Liu, Y F Liu, J Liu, Y Huang, G F Xu, J Cai, Y Chen, Y Q Wu, Y Y Ying, R J Zhang, D Zhang
BACKGROUND: Anesthesia is commonly used for surgical termination of the extrauterine component of heterotopic pregnancy. We sought to evaluate the effects of general and regional anesthesia during salpingectomy on reproductive and obstetric outcomes of heterotopic pregnancies. METHODS: A two-center, retrospective cohort study was conducted, and 49 heterotopic pregnancies were included. Baseline characteristics, reproductive and obstetric outcomes were compared between the general anesthesia and regional anesthesia groups...
December 7, 2017: International Journal of Obstetric Anesthesia
K Lato, I Bekes, Peter Widschwendter, T W P Friedl, W Janni, F Reister, G Froeba, U Friebe-Hoffmann
PURPOSE: Hypotension due to spinal anesthesia is a well-known side effect in pregnant women receiving caesarean section. Little is known about its impact on fetal blood circulation. METHODS: 40 women with uncomplicated singleton term pregnancies prepared for caesarean section were prospectively evaluated by Doppler sonography before and immediately after spinal anesthesia. RESULTS: In 90% of the women, blood pressure significantly decreased after spinal anesthesia and 42...
January 12, 2018: Archives of Gynecology and Obstetrics
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