International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2010
Double-space combined spinal-epidural technique for elective caesarean section: a review of 10 years' experience in a UK teaching maternity unit.
In obstetric practice use of a regional technique with a low failure rate minimises the need to convert to general anaesthesia (GA). Previous studies have suggested that combined spinal-epidural anaesthesia (CSE) has a lower GA conversion rate than spinal or epidural anaesthesia alone. In addition, a double-space CSE may be associated with fewer failures than the needle-through-needle technique. However, whether this has an effect on GA conversion rate is unknown. We aimed to review our practice of the double-space CSE technique for elective caesarean section. ⋯ Compared to previously published work using spinal or needle-through-needle CSE anaesthesia we have found a lower GA conversion rate in our unit using the double-space CSE technique for elective caesarean section.
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Int J Obstet Anesth · Apr 2010
Case ReportsCardiac arrest due to uterine inversion during caesarean section.
We describe the case of a 20-year-old G3P0 woman who was delivered by caesarean section under general anaesthesia, complicated by uterine inversion secondary to undiagnosed placenta accreta and cardiac arrest requiring cardiopulmonary resuscitation. Uterine inversion is a known complication of placenta accreta and is a rare occurrence at caesarean section. Similar cases have been reported, though cardiac arrest is an uncommon feature. The possible causes and management are discussed.
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Int J Obstet Anesth · Apr 2010
Prospective observational study of serial cardiac output by transthoracic echocardiography in healthy pregnant women undergoing elective caesarean delivery.
An understanding of cardiovascular changes in parturients is crucial for their anaesthetic management, but few studies have examined the effect of posture on cardiac output in the peripartum period. ⋯ Cardiac output showed large variability and was lower than previously reported. Cardiac output decreased with the left lateral 10 degrees head-down position due to a reduction in stroke volume that has not previously been reported. The transthoracic examination was acceptable to all women.