International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2006
ReviewPractical management of the parturient with congenital heart disease.
Cardiac disease is becoming more common in women presenting for maternity care and is a major cause of maternal mortality in the UK. We present a review of the management of parturients with congenital heart disease, focusing on practical aspects and the problems that may be expected.
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Int J Obstet Anesth · Apr 2006
Case ReportsOn knots in epidural catheters: a case report and a review of the literature.
A lumbar epidural catheter placed for labor analgesia proved to be difficult to remove after an uneventful delivery. With the patient in the position of catheter insertion, i.e. seated, firm and steady traction allowed removal of the catheter and revealed a knot 4 mm from its tip. Passing excessive amount of catheter into the epidural space may have contributed to this complication. Guidelines to prevent and to minimize this complication are suggested.
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Int J Obstet Anesth · Apr 2006
Informed consent for labor epidurals: a survey of Society for Obstetric Anesthesia and Perinatology anesthesiologists from the United States.
Ethicists agree that informed consent is a process rather than just simply the signing of a form. It should provide the patient with needed information and understanding to authorize a procedure. Essential elements of informed consent for women requesting labor epidurals include a description of the procedure, the risks and benefits, and alternative treatments for analgesia including the associated risks and benefits. The purpose of this pilot study was to determine practices and opinions of obstetric anesthesiologists regarding informed consent for parturients. ⋯ Despite the painful, stressful circumstances confronted by parturients, many respondents (76% in academic, 64% in private practice) thought that women in active labor are able to give informed consent.
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Int J Obstet Anesth · Apr 2006
Obstetric regional blocks for women with multiple sclerosis: a survey of UK experience.
There has been a reluctance to use regional blocks for women with multiple sclerosis as effects on the course of the disease are unclear. We assessed the views of UK consultant obstetric anaesthetists regarding management of women with multiple sclerosis. ⋯ Most UK anaesthetists would perform regional blocks for labour and caesarean section in multiple sclerosis, although the experience of each anaesthetist is limited. Many emphasised the need for thorough pre-assessment and informed consent.
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Int J Obstet Anesth · Apr 2006
Case ReportsCoronary arterial air embolus occurring during cesarean delivery.
We present a case of a severe systemic (paradoxical) air embolism occurring during spinal anesthesia for cesarean delivery in an otherwise healthy 35-year-old parturient. Uncomplicated spinal anesthesia and satisfactory surgical anesthesia were obtained; no sedatives were used and the patient was awake and alert and tolerating the procedure well. Immediately following infant and placental delivery (approximately 25 min after the spinal anesthetic was induced) the patient had acute onset of markedly decreased mental status, profound ventricular ectopy and labile blood pressure. ⋯ Neurologic status returned to normal by the end of the surgery, but electrocardiogram findings in the immediate postoperative period were consistent with myocardial ischemia and serial cardiac troponin levels confirmed myocardial injury. On postoperative day 1, an echocardiogram demonstrated the presence of a patent foramen ovale. The events in this case are likely to be due to paradoxical coronary and cerebral air embolism.