International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2008
Difficult and failed intubation in obstetric anaesthesia: an observational study of airway management and complications associated with general anaesthesia for caesarean section.
Recent developments in anaesthesia and patient demographics have potentially changed the practice of obstetric general anaesthesia. There are few contemporary data on Australasian practice of general anaesthesia for caesarean section, especially relating to airway management, anaesthetic techniques and complications. ⋯ General anaesthesia is most commonly used in emergency situations. Tracheal intubation after rapid-sequence induction remains the predominant approach to airway management in Australasia. The incidence of failed intubation is consistent with previous studies. Aspiration prophylaxis is not routinely used for emergency surgery.
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In May 2005 the Obstetric Anaesthetists' Association (OAA) and Association of Anaesthetists of Great Britain and Ireland published a document entitled Guidelines for Obstetric Anaesthetic Services. This survey investigated if standards recommended in this document were being met more than six months after its release. ⋯ This national survey illustrates to what extent UK departments meet national guidelines for provision of obstetric anaesthesia services. It also highlights areas for improvement nationally and could be used by individual units to plan resources in the future.
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Int J Obstet Anesth · Oct 2008
Ten years of experience with accidental dural puncture and post-dural puncture headache in a tertiary obstetric anaesthesia department.
Accidental dural puncture (ADP) and post-dural puncture headache (PDPH) are important complications of obstetric regional anaesthesia. ⋯ The incidence of ADP, PDPH, blood patching and repeat blood patching is similar to previous studies. Many ADPs are unrecognised during epidural insertion. CSE does not appear to increase the risk of ADP or PDPH; 29-gauge rather than 27-gauge pencil-point spinal needles conferred no benefit. Inserting the epidural catheter intrathecally did not significantly reduce the incidence of PDPH and blood patching in our series.
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Int J Obstet Anesth · Oct 2008
Case ReportsAnaesthesia for caesarean section in a patient with Ehlers-Danlos syndrome associated with postural orthostatic tachycardia syndrome.
We report the use of regional anaesthesia for elective caesarean section in a primigravida with hypermobility type Ehlers-Danlos syndrome (type III) associated with postural orthostatic tachycardia syndrome. Single-shot spinal anaesthesia was performed after failed epidural anaesthesia. This genotype, although generally associated with fewer antenatal and peripartum complications, is more likely than other types to display dysautonomia and orthostatic intolerance. This requires careful management for delivery.