International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2009
Review Meta AnalysisPeripartum anesthetic management of patients with aortic valve stenosis: a retrospective study and literature review.
Anesthetic management of parturients with aortic stenosis is controversial. Early studies suggest maternal mortality was related to cardiac condition and anesthetic care. In this report, management of parturients with moderate or severe aortic stenosis in two institutions is compared, and published cases are reviewed. ⋯ Carefully titrated regional analgesia is usually well tolerated in patients undergoing vaginal or cesarean delivery even in the presence of severe aortic stenosis. Standard monitoring is usually adequate for vaginal delivery, but invasive monitoring may facilitate management in some patients. An arterial line allows close monitoring of systemic blood pressure. Facilities for close 24-48-h post-partum observation should be available. A multidisciplinary approach is needed.
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Int J Obstet Anesth · Oct 2009
Randomized Controlled Trial Comparative StudyLow-dose epidural top up for emergency caesarean delivery: a randomised comparison of levobupivacaine versus lidocaine/epinephrine/fentanyl.
Levobupivacaine has a greater safety margin for cardiotoxicity than bupivacaine; consequently it has been recommended as the agent of choice for extending low-dose epidural analgesia for emergency caesarean section. We wished to compare the onset of levobupivacaine with that of a 2% lidocaine/epinephrine/fentanyl mixture. ⋯ A freshly prepared mixture of 2% lidocaine 20 mL plus epinephrine 100 mug and fentanyl 100 mug provides a more rapid onset and superior quality T7 block to touch than 0.5% levobupivacaine 20 mL.