International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2012
Effect of μ-opioid receptor A118G polymorphism on the ED50 of epidural sufentanil for labor analgesia.
A common polymorphism of the μ-opioid receptor gene (OPRM1, p.118A/G), which has been shown to effect the response to neuraxial opioids, occurs in 30% of Caucasian women. This double-blind up-down sequential allocation study was designed to examine the effect of p.118A/G on the ED50 of epidural sufentanil for labor analgesia. ⋯ Women carrying the variant allele of p.118A/G of OPRM1 (G118) had a lower ED50 for epidural sufentanil given for early labor analgesia than women homozygous for the wild-type allele.
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Int J Obstet Anesth · Jan 2012
Case ReportsTransfusion practice in major obstetric haemorrhage: lessons from trauma.
The management of massive haemorrhage with blood products is changing as evidence arrives from civilian and military trauma. Rapid early replacement of coagulation factors and platelets is now becoming central to improving outcome, usually given in higher ratios with respect to red cell units than previously recommended and using empiric transfusion based on clinical rather than laboratory parameters. The management of three cases of major obstetric haemorrhage based on these principles is presented. ⋯ Each patient had acceptable full blood count and coagulation results after surgery and all made an uneventful recovery. These outcomes support the opinion that major obstetric haemorrhage can be managed in a similar fashion to blood loss in trauma. Recommendations from the Association of Anaesthetists of Great Britain and Ireland, and the UK National Patient Safety Agency should be considered during major obstetric haemorrhage.
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Int J Obstet Anesth · Jan 2012
Case ReportsMultidisciplinary management of an obstetric patient with glycogen storage disease type 3.
A 22-year-old primiparous woman with known glycogen storage disease type 3a presented to our hospital during her 12th week of pregnancy. Glycogen storage disease type 3 is a rare inherited disorder resulting from a deficiency of the glycogen debranching enzyme, causing the accumulation of abnormal short-chain glycogen in liver, blood cells, myocardium and striated muscle. Symptoms improve after puberty but the increased metabolism of pregnancy predisposes to hypoglycaemia, ketosis and lactic acidosis. ⋯ Intravenous dextrose infusion and regular blood glucose monitoring were used during the perinatal period to prevent hypoglycaemia. An arterial line was inserted in the operating room for frequent blood sampling and to avoid muscle cramps which could be induced by the intermittent inflation of the automated blood pressure cuff. Obstetric, anaesthetic and neonatal outcomes were uneventful.
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Type A aortic dissection is a life-threatening event to both mother and baby, and accounted for 14% of maternal cardiac deaths in the 2006-2008 UK Confidential Enquiries into Maternal Deaths. Difficulty exists in the diagnosis of this rare but potentially curable condition, the mortality of which increases with delay in diagnosis. ⋯ The acute presentation of aortic dissection and diagnostic clues that may have expedited the diagnosis are discussed. A brief literature review is presented of the perioperative management of patients undergoing cardiothoracic surgery post-caesarean section and the modifications to standard techniques that are required.