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Obstetric anaesthesia

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17 papers 25 to 100 followers
https://www.readbyqxmd.com/read/27555797/current-best-practice-in-the-management-of-hypertensive-disorders-in-pregnancy
#1
REVIEW
Rosemary Townsend, Patrick O'Brien, Asma Khalil
Preeclampsia is a potentially serious complication of pregnancy with increasing significance worldwide. Preeclampsia is the cause of 9%-26% of global maternal mortality and a significant proportion of preterm delivery, and maternal and neonatal morbidity. Incidence is increasing in keeping with the increase in obesity, maternal age, and women with medical comorbidities entering pregnancy. Recent developments in the understanding of the pathophysiology of preeclampsia have opened new avenues for prevention, screening, and management of this condition...
2016: Integrated Blood Pressure Control
https://www.readbyqxmd.com/read/27574464/managing-anesthesia-for-cesarean-section-in-obese-patients-current-perspectives
#2
REVIEW
Agnes M Lamon, Ashraf S Habib
Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients...
2016: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/27619509/remifentanil-for-labor-analgesia-a-comprehensive-review
#3
Yayoi Ohashi, Leyla Baghirzada, Hiroyuki Sumikura, Mrinalini Balki
Japan has seen significant developments in obstetric anesthesia in recent years, including the establishment of the Japanese Society of Obstetric Anesthesia and Perinatology. However, labor pain, which is one of the most important issues in obstetric practice, is still not treated aggressively. The rate of epidural administration for labor analgesia is very low in Japan as compared to other developed countries. Remifentanil has been used for labor analgesia, as part of general anesthesia for cesarean delivery, as well as for various fetal procedures around the world...
September 12, 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/27465522/current-evidence-is-not-in-support-of-lipid-rescue-therapy-in-local-anaesthetic-systemic-toxicity
#4
EDITORIAL
P H Rosenberg
No abstract text is available yet for this article.
September 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27443376/hypertensive-disorders-of-pregnancy
#5
Ana Sjaus, Dolores M McKeen, Ronald B George
PURPOSE: In this continuing professional development module, we review recent Society of Obstetricians and Gynaecologists of Canada (SOGC) guidelines for the classification and diagnosis of hypertensive disorders of pregnancy (HDP) as well as review the clinical features, laboratory investigations, and outcomes of HDP. We explore the evidence for anesthetic management and prevention of end-organ damage in women with HDP and describe the role and contribution of anesthesiologists as part of a multidisciplinary care team...
September 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/27307177/transversus-abdominal-plane-block-for-postoperative-analgesia-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#6
Etrusca Brogi, Roy Kazan, Shantale Cyr, Francesco Giunta, Thomas M Hemmerling
PURPOSE: The transversus abdominal plane (TAP) block has been described as an effective pain control technique after abdominal surgery. We performed a systematic review and meta-analysis of randomized-controlled trials (RCTs) to account for the increasing number of TAP block studies appearing in the literature. The primary outcome we examined was the effect of TAP block on the postoperative pain score at six, 12, and 24 hr. The secondary outcome was 24-hr morphine consumption. SOURCE: We searched the United States National Library of Medicine database, the Excerpta Medica database, and the Cochrane Central Register of Controlled Clinical Studies and identified RCTs focusing on the analgesic efficacy of TAP block compared with a control group [i...
October 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/26446688/anesthetic-considerations-in-hellp-syndrome
#7
REVIEW
M del-Rio-Vellosillo, J J Garcia-Medina
BACKGROUND: HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is an obstetric complication with heterogonous presentation and multisystemic involvement. It is characterized by microangiopathic hemolytic anemia, elevated liver enzymes by intravascular breakdown of fibrin in hepatic sinusoids and reduction of platelet circulation by its increased consumption. METHODS: In terms of these patients' anesthetic management, it is essential to consider some details: (1) effective, safe perioperative management by a multidisciplinary approach, and quick, good communication among clinical specialists to achieve correct patient management; (2) neuroaxial block, particularly spinal anesthesia, is the first choice to do the cesarean if there is only moderate, but not progressive thrombocytopenia; (3) if a general anesthesia is required, it is necessary to control the response to stress produced by intubation, especially in patients with either severe high blood pressure or neurological signs, or to prevent major cerebral complications; (4) invasive techniques, e...
February 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/26580836/practice-guidelines-for-obstetric-anesthesia-an-updated-report-by-the-american-society-of-anesthesiologists-task-force-on-obstetric-anesthesia-and-the-society-for-obstetric-anesthesia-and-perinatology
#8
https://www.readbyqxmd.com/read/26342729/pre-eclampsia
#9
REVIEW
Ben W J Mol, Claire T Roberts, Shakila Thangaratinam, Laura A Magee, Christianne J M de Groot, G Justus Hofmeyr
Pre-eclampsia affects 3-5% of pregnancies and is traditionally diagnosed by the combined presentation of high blood pressure and proteinuria. New definitions also include maternal organ dysfunction, such as renal insufficiency, liver involvement, neurological or haematological complications, uteroplacental dysfunction, or fetal growth restriction. When left untreated, pre-eclampsia can be lethal, and in low-resource settings, this disorder is one of the main causes of maternal and child mortality. In the absence of curative treatment, the management of pre-eclampsia involves stabilisation of the mother and fetus, followed by delivery at an optimal time...
March 5, 2016: Lancet
https://www.readbyqxmd.com/read/26348379/an-update-on-the-use-of-massive-transfusion-protocols-in-obstetrics
#10
REVIEW
Luis D Pacheco, George R Saade, Maged M Costantine, Steven L Clark, Gary D V Hankins
Obstetrical hemorrhage remains a leading cause of maternal mortality worldwide. New concepts involving the pathophysiology of hemorrhage have been described and include early activation of both the protein C and fibrinolytic pathways. New strategies in hemorrhage treatment include the use of hemostatic resuscitation, although the optimal ratio to administer the various blood products is still unknown. Massive transfusion protocols involve the early utilization of blood products and limit the traditional approach of early massive crystalloid-based resuscitation...
March 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/26032446/severe-pain-during-local-infiltration-for-spinal-anaesthesia-predicts-post-caesarean-pain
#11
S Orbach-Zinger, A Aviram, S Fireman, T Kadechenko, Z Klein, N Mazarib, A Artiuch, A Reuveni, A Ioscovich, L A Eidelman, R Landau
BACKGROUND: Quantitative sensory testing (QST) measures response to painful stimuli and has been used to predict post-caesarean pain. Pain reported upon intravenous cannulation was shown to predict epidural analgesic use and pain intensity during labour. We hypothesized that pain intensity reported by women upon local anaesthesia injection (ILA) for spinal anaesthesia may predict acute pain after caesarean delivery (CD). METHODS: In a prospective observational trial, 229 women undergoing elective CD under spinal anaesthesia were enrolled...
October 2015: European Journal of Pain: EJP
https://www.readbyqxmd.com/read/25902327/the-ed90-of-prophylactic-oxytocin-infusion-after-delivery-of-the-placenta-during-cesarean-delivery-in-laboring-compared-with-nonlaboring-women-an-up-down-sequential-allocation-dose-response-study
#12
Anne Lavoie, Robert J McCarthy, Cynthia A Wong
BACKGROUND: Prophylactic administration of oxytocin as a part of active management of the third stage of labor reduces the risk of postpartum hemorrhage. Prophylactic oxytocin is often administered as an infusion rather than a bolus. The aim of the current up-down sequential allocation dose-response study was to test the hypothesis that parturients who receive intrapartum exogenous oxytocin therapy, and who subsequently undergo cesarean delivery for labor dystocia, will have a higher estimated effective dose in 90% of paturients (ED90) for oxytocin infusion in the third stage of labor compared with nonlaboring parturients...
July 2015: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/25804214/defining-competence-in-obstetric-epidural-anaesthesia-for-inexperienced-trainees
#13
E J Drake, J Coghill, J R Sneyd
BACKGROUND: Cumulative sum (CUSUM) analysis has been used for assessing competence of trainees learning new technical skills. One of its disadvantages is the required definition of acceptable and unacceptable success rates. We therefore monitored the development of competence amongst trainees new to obstetric epidural anaesthesia in a large public hospital. METHODS: Obstetric epidural data were collected prospectively between January 1996 and December 2011. Success rates for inexperienced trainees were calculated retrospectively for (1) the whole database, (2) for each consecutive attempt and (3) each trainee's individual overall success rate...
June 2015: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/25413847/quality-of-pain-treatment-after-caesarean-section-results-of-a-multicentre-cohort-study
#14
MULTICENTER STUDY
H Marcus, H J Gerbershagen, L M Peelen, S Aduckathil, T H Kappen, C J Kalkman, W Meissner, U M Stamer
BACKGROUND: A large cohort study recently reported high pain scores after caesarean section (CS). The aim of this study was to analyse how pain after CS interferes with patients' activities and to identify possible causes of insufficient pain treatment. METHODS: We analysed pain scores, pain-related interferences (with movement, deep breathing, mood and sleep), analgesic techniques, analgesic consumption, adverse effects and the wish to have received more analgesics during the first 24 h after surgery...
August 2015: European Journal of Pain: EJP
https://www.readbyqxmd.com/read/19672175/placental-transfer-and-fetal-metabolic-effects-of-phenylephrine-and-ephedrine-during-spinal-anesthesia-for-cesarean-delivery
#15
RANDOMIZED CONTROLLED TRIAL
Warwick D Ngan Kee, Kim S Khaw, Perpetua E Tan, Floria F Ng, Manoj K Karmakar
BACKGROUND: Use of ephedrine in obstetric patients is associated with depression of fetal acid-base status. The authors hypothesized that the mechanism underlying this is transfer of ephedrine across the placenta and stimulation of metabolism in the fetus. METHODS: A total of 104 women having elective Cesarean delivery under spinal anesthesia randomly received infusion of phenylephrine (100 microg/ml) or ephedrine (8 mg/ml) titrated to maintain systolic blood pressure near baseline...
September 2009: Anesthesiology
https://www.readbyqxmd.com/read/21350228/the-unanticipated-difficult-intubation-in-obstetrics
#16
REVIEW
Jill M Mhyre, David Healy
In this focused review, we discuss an algorithm specifically for the unanticipated difficult intubation in obstetrics. This generic algorithm emphasizes a standardized and prespecified sequence of interventions to provide safe, efficient, and effective airway management for the emergency obstetric surgical patient. Individual institutions and anesthesia providers are encouraged to use this framework to select specific pieces of equipment for each step, and to create regular opportunities for all obstetric anesthesia providers to become facile with each airway device and to integrate the algorithm under simulated conditions...
March 2011: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/19384122/early-compared-with-late-neuraxial-analgesia-in-nulliparous-labor-induction-a-randomized-controlled-trial
#17
RANDOMIZED CONTROLLED TRIAL
Cynthia A Wong, Robert J McCarthy, John T Sullivan, Barbara M Scavone, Susan E Gerber, Edward A Yaghmour
OBJECTIVE: To determine whether early initiation of neuraxial analgesia (anesthetic[s] placed around the nerves of the central nervous system) compared with systemic opioid analgesia, followed later in labor by epidural analgesia, increases the rate of cesarean delivery in nulliparas undergoing induction of labor. METHODS: Nulliparas undergoing induction of labor who requested analgesia when cervical dilation was less than 4 cm participated in the study. Patients were randomized to neuraxial (early) or systemic opioid (late) analgesia at the first analgesia request...
May 2009: Obstetrics and Gynecology
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