International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2011
Estimation of infant dose and exposure to pethidine and norpethidine via breast milk following patient-controlled epidural pethidine for analgesia post caesarean delivery.
There is no information about the distribution of pethidine into breast milk and/or exposure of the breastfed infant during pethidine patient-controlled epidural analgesia after caesarean delivery. ⋯ The combined absolute infant dose of pethidine and norpethidine received via milk was 1.8% of the neonatal therapeutic dose and the combined relative infant dose was below the 10% recommended safety level. Breastfed infants are at low risk of drug exposure when mothers self-administer epidural pethidine after caesarean delivery.
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Int J Obstet Anesth · Apr 2011
An observational study of factors leading to difficulty in resident anaesthesiologists identifying the epidural space in obstetric patients.
Multiple attempts at needle placement for neuraxial block may cause patient discomfort, a higher incidence of spinal haematomas, postdural puncture headache and nerve trauma. The aim of this study was to evaluate the factors predicting difficult epidural analgesia for inexperienced residents. ⋯ For residents with no prior experience in obstetric anaesthesia, the most reliable factor in predicting difficult epidural cannulation was spinal abnormality.
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Postpartum haemorrhage is an important cause of maternal morbidity and mortality. It is associated with haemostatic impairment which may exacerbate bleeding. ⋯ Fibrinogen level was the parameter that best correlated with increasing volume of haemorrhage and was the most useful marker of developing haemostatic impairment. Guidelines for fresh frozen plasma use in major postpartum haemorrhage were rarely followed and should be reviewed.