International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2012
Randomized Controlled TrialEfficacy of dexmedetomidine in suppressing cardiovascular and hormonal responses to general anaesthesia for caesarean delivery: a dose-response study.
Preoperative dexmedetomidine administration blunts haemodynamic and hormonal responses to tracheal intubation and reduces anaesthetic requirements. We hypothesized that dexmedetomidine would reduce the maternal haemodynamic and hormonal responses to elective caesarean delivery without harmful neonatal effects. ⋯ Preoperative administration of dexmedetomidine 0.4 and 0.6 μg/kg/h is effective in attenuating the maternal haemodynamic and hormonal responses to caesarean delivery under sevoflurane anaesthesia without adverse neonatal effects.
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Int J Obstet Anesth · Jul 2012
ReviewThe National Institute for Health and Clinical Excellence (NICE) guidelines for caesarean section, 2011 update: implications for the anaesthetist.
In 2004 the first National Institute for Health and Clinical Excellence guidelines on caesarean section were published with the aim of providing evidence-based recommendations for best practice. With the publication of new evidence, the guidelines have been revised with the second edition released in 2011. This review highlights the changes that have been made which are of specific relevance to obstetric anaesthetists including planned caesarean section compared with vaginal birth in healthy women with an uncomplicated pregnancy; management of the morbidly adherent placenta; mother-to-child transmission of maternal infections; maternal request for caesarean section; decision-to-delivery interval for emergency caesarean section; timing of antibiotic administration and childbirth after caesarean section.
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Int J Obstet Anesth · Jul 2012
Case ReportsSubcapsular liver hematoma causing cardiac tamponade in HELLP syndrome.
HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome is an obstetric complication with heterogeneous presentation, multisystem involvement and variable prognosis, but which usually resolves after delivery. We report a case of HELLP syndrome with subcapsular hematoma of the liver causing extrapericardial cardiac tamponade. The subcapsular hematoma and cardiac tamponade were managed conservatively.
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Int J Obstet Anesth · Jul 2012
Prospective evaluation of systolic arterial pressure control with a phenylephrine infusion regimen during spinal anaesthesia for caesarean section.
Hypotension and nausea occur frequently during spinal anaesthesia for caesarean section. The aim of this evaluation was to assess systolic arterial pressure control with our routine prophylactic intravenous phenylephrine infusion regimen. We audited a local standard for an incidence of hypotension of ≤ 25% during the first 15 min of anaesthesia. ⋯ Our routine phenylephrine infusion regimen was effective at minimizing hypotension and nausea during relatively high-dose spinal anaesthesia. This was achieved with a low intervention rate, in conjunction with a 2-min rather than a 1-min non-invasive blood pressure cycle time and a relatively low volume of intravenous fluid.