International journal of obstetric anesthesia
-
Int J Obstet Anesth · Jan 2013
Case ReportsElectrical impedance tomography may optimize ventilation in a postpartum woman with respiratory failure.
Amniotic fluid embolism is a rare peripartum complication with the sudden onset of haemodynamic instability, respiratory failure and coagulopathy during labour or soon after delivery. A 31-year-old woman with amniotic fluid embolism was treated with vasopressors, inotropes, intravenous fluid, tranexamic acid and ventilatory support. Assessment of respiratory impairment was made using conventional chest X-ray, computed tomography and electrical impedance tomography. The potential for electrical impedance tomography to improve monitoring and guide respiratory therapy is explored.
-
Int J Obstet Anesth · Jan 2013
Efficacy and safety of intraoperative intravenous methadone during general anaesthesia for caesarean delivery: a retrospective case-control study.
Most patients undergoing caesarean delivery with general anaesthesia require systemic opioid administration. Due to its rapid onset and long duration of action, intravenous methadone may make it suitable for analgesia after caesarean delivery. Intraoperative methadone combined with postoperative intravenous patient-controlled analgesia with fentanyl or morphine has recently been introduced in our unit. ⋯ A single intraoperative bolus of intravenous methadone appeared to provide effective analgesia with an acceptable side-effect profile.
-
Int J Obstet Anesth · Jan 2013
Case ReportsManagement of a parturient with an anterior sacral meningocele.
Anterior sacral meningoceles are rare disorders featuring anterior herniation of the meninges through a sacral defect or foramen. They are frequently misdiagnosed as ovarian or abdominal cysts and surgical exploration has resulted in meningitis. In pregnancy it represents an obstacle to delivery of the fetus and rupture of the meningocele during vaginal delivery is a significant risk. The successful multidisciplinary management of a primiparous patient with an anterior sacral meningocele and previous abdominal surgery is presented.
-
Int J Obstet Anesth · Jan 2013
Efficacy and side effects of intravenous remifentanil patient-controlled analgesia used in a stepwise approach for labour: an observational study.
Remifentanil has a suitable pharmacological profile for labour analgesia. In this prospective, observational study, intravenous patient-controlled analgesia with remifentanil, using stepwise bolus doses without background infusion, was examined during the first and second stages of labour. Outcomes were pain reduction, maternal satisfaction, maternal and neonatal side effects and remifentanil metabolism in the neonate. ⋯ Remifentanil intravenous patient-controlled analgesia provides adequate pain relief and high maternal satisfaction during the first and second stages of labour. Maternal sedation and respiratory depression may occur, but no serious neonatal side effects were recorded. Careful monitoring is mandatory.