International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2012
ReviewWhat's new in obstetric anesthesia: the 2011 Gerard W. Ostheimer lecture.
The Gerard W. Ostheimer lecture is delivered at the Society for Obstetric Anesthesia and Perinatology Annual Meeting. The lecture provides a comprehensive review of the previous year's literature in obstetric anesthesia, obstetrics, perinatology, and health services research relevant for obstetric anesthesiologists. This article covers several of the major themes that emerged from the 2010 literature.
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Int J Obstet Anesth · Jan 2012
Case ReportsPeripartum management of two parturients with ornithine transcarbamylase deficiency.
Ornithine transcarbamylase deficiency is a rare X-linked disorder in which female carriers are usually heterozygous for the ornithine transcarbamylase deficiency gene. In pregnancy it has been associated with altered mental status, seizures, coma and death, especially in the postpartum period. ⋯ Neuraxial techniques were used for pain relief in labor and anesthesia for operative delivery. A dextrose infusion provided caloric intake during labor and perioperatively.
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Int J Obstet Anesth · Jan 2012
Case ReportsAnesthetic management of vaginal delivery in a parturient with hemochromatosis induced end-organ failure.
The vast majority of females affected by hemochromatosis are asymptomatic during childbearing years. We were able to provide effective obstetric anesthesia care to a 35-year-old woman with severe hemochromatosis. She had systolic heart failure with a left ventricular ejection fraction of 15%, severe pulmonary hypertension, mitral insufficiency, a history of ventricular tachycardia, cirrhosis, obstructive sleep apnea, gestational diabetes, and severe scoliosis. ⋯ An arterial line and epidural analgesic were placed before induction of labor. Vaginal delivery was accomplished with passive decent of the fetus and forceps assistance. We discuss hemochromatosis and its implications for the parturient.
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Int J Obstet Anesth · Jan 2012
Case ReportsPerioperative management of a parturient with hyponatraemia due to carbamazepine therapy.
We describe the perioperative management of an epileptic parturient who developed hyponatraemia due to carbamazepine therapy. Caesarean delivery was performed under combined spinal-epidural anaesthesia with a good outcome for both mother and neonate. The diagnostic and therapeutic approach, anaesthetic implications and maternal and neonatal risks for a patient with hyponatraemia complicating carbamazepine therapy are discussed.
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Int J Obstet Anesth · Jan 2012
Assessment of salivary amylase as a stress biomarker in pregnant patients.
Chronic stress during pregnancy has been associated with worsened maternal and fetal outcomes. Acute stress immediately before spinal anaesthesia for caesarean section may contribute to hypotension. Therefore objective measures of acute stress may help identify women at risk of adverse outcomes. Salivary alpha-amylase is a stress biomarker that has so far been poorly investigated during pregnancy. The reference change value is the difference between two sequential results that must be exceeded for a change to be considered clinically relevant. Our first aim was to determine if salivary alpha-amylase increased in pregnant patients when subjected to the stress of transfer to the operating room. Our second aim was to determine if changes in salivary alpha-amylase were likely to be clinically significant by measuring reference change value in healthy volunteers. ⋯ When pregnant women are taken to the operating room, a clinically and statistically significant increase in salivary alpha-amylase was observed. Further studies are required to define its clinical usefulness.