International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2005
Some immediate serious complications of obstetric epidural analgesia and anaesthesia: a prospective study of 145,550 epidurals.
Inadvertent intravascular, intrathecal or subdural injection in obstetric regional analgesia are potentially life-threatening, so following a catastrophic complication it was decided to collect data regionally. ⋯ The incidence of intravascular, intrathecal and subdural injection and of high or total spinal block was similar to that found in previous prospective studies in obstetric and non-obstetric patients. The incidence of these complications has not changed and is not related to the number of deliveries or the epidural rate in obstetric units.
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Int J Obstet Anesth · Jan 2005
Case ReportsAnaesthetic management during labour of a manifesting carrier of Duchenne muscular dystrophy.
We describe the peripartum anaesthetic management of a 36-year-old woman who was a manifesting carrier of Duchenne muscular dystrophy. Duchenne muscular dystrophy is an X-linked recessive disorder affecting young males associated with severe complications during anaesthesia if depolarising neuromuscular blocking drugs and volatile agents are used. ⋯ We planned to establish regional anaesthesia should an operation be necessary during labour or delivery and to use propofol total intravenous anaesthesia and rocuronium if general anaesthesia became unavoidable. At 37 weeks, the woman went into spontaneous labour, but fetal distress necessitated caesarean section for which combined spinal-epidural anaesthesia was used.
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Int J Obstet Anesth · Jan 2005
Per-operative cerebral near-infrared spectroscopy (NIRS) predicts maternal hypotension during elective caesarean delivery in spinal anaesthesia.
Spinal anaesthesia-induced maternal hypotension is common during elective caesarean section. This study evaluated whether cerebral near-infrared spectroscopy predicts maternal hypotension, defined as a 25% reduction in systolic blood pressure or heart rate or presentation of clinical symptoms. ⋯ The results demonstrate a relationship between ScO(2) and impending hypotension during low-dose spinal anaesthesia for elective caesarean section. We suggest that immediate measures are taken to stabilise blood pressure if the near-infrared spectroscopy determined cerebral oxygenation decreases by more than 5%.