International journal of obstetric anesthesia
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Intrathecal anaesthesia, either as a single shot-spinal or as part of a combined spinal-epidural technique, is now widely accepted as the management of choice for caesarean section. It generally produces rapid and predictable anaesthesia, yet occasionally fails for no apparent reason. Four case reports of seemingly inexplicable complete failure of intrathecal anaesthesia are presented, together with a literature review of other cases and possible causes of the failure, which include anatomical abnormality, drug failure and management failure.
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Int J Obstet Anesth · Jul 2007
Case ReportsVentricular bigeminy during phenylephrine infusion used to maintain normotension during caesarean section under spinal anaesthesia.
A 31-year-old primiparous, healthy woman presented for emergency caesarean section. Following the siting of a spinal anaesthetic, seconds after starting a phenylephrine infusion, she developed ventricular bigeminy. ⋯ The possible proarrhythmic and antiarrhythmic effects of phenylephrine are discussed. We suggest that this was most probably a stretch-induced ventricular arrhythmia due to increased ventricular afterload.
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Int J Obstet Anesth · Jul 2007
ReviewBlood conservation techniques in obstetrics: a UK perspective.
In the UK, maternal mortality due to haemorrhage appears to be rising, with obstetric haemorrhage accounting for 3-4% of the red cells transfused. Allogeneic blood transfusion carries risks such as administration errors, transmitted infections and immunological reactions. The supply of blood is decreasing, partly due to the exclusion of donors who have themselves received a blood transfusion since 1980, in order to stop transmission of variant-Creutzfeldt-Jakob disease. ⋯ Acute normovolaemic haemodilution may induce anaemia and cardiac failure and cannot be used in an emergency. It may have a limited role in combination with other techniques. Intra-operative cell salvage is more effective and useful in obstetrics than the other techniques, overcomes their shortcomings and is endorsed by CEMACH, OAA/AAGBI Guidelines, the National Blood Service and NICE.