International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2008
Case ReportsCerebral venous sinus thrombosis following accidental dural puncture and epidural blood patch.
We report the case of a woman who developed cerebral venous sinus thrombosis after an attempted epidural. The epidural was complicated by an accidental dural puncture and the ensuing headache was initially treated with an epidural blood patch. Cerebral venous sinus thrombosis is an uncommon condition with varying aetiology and risk factors. We discuss the importance of the differential diagnosis for postpartum headache and explore the relationship between cerebral venous sinus thrombosis and the triad of pregnancy, dural puncture and epidural blood patch.
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Int J Obstet Anesth · Jul 2008
Case ReportsThe hemodynamics of oxytocin and other vasoactive agents during neuraxial anesthesia for cesarean delivery: findings in six cases.
Oxytocin is a commonly used uterotonic that can cause significant and even fatal hypotension, particularly when given as a bolus. The resulting hypotension can be produced by a decrease in systemic vascular resistance or cardiac output through a decrease in venous return. Parturients with normal volume status, heart valves and pulmonary vasculature most often respond to this hypotension with a compensatory increase in heart rate and stroke volume. ⋯ Pulse power analysis was conducted in six cases of cesarean delivery performed under neuraxial anesthesia. Hypotension in response to oxytocin was associated with a decrease in systemic vascular resistance and a compensatory increase in stroke volume, heart rate and cardiac output. Pulse power analysis may be helpful in determining the etiology of and treating hypotension during cesarean delivery under neuraxial anesthesia.
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Int J Obstet Anesth · Jul 2008
Randomized Controlled Trial Multicenter StudyVaginal twin delivery: a survey and review of location, anesthesia coverage and interventions.
Twin pregnancies are associated with increased perinatal morbidity and mortality. No consensus exists whether vaginal twin delivery should take place in the labor room or operating room, or whether anesthesiologists should be present. We surveyed members of the California Society of Anesthesiologists (CSA) to review management of vaginal twin delivery, and examined anesthetic intervention retrospectively at our institution. ⋯ There is a lack of consensus regarding the appropriate location for vaginal twin delivery and the role of anesthesiologists. A significant percentage of women undergoing vaginal twin delivery in our institution received anesthetic intervention in the immediate delivery period.