International journal of obstetric anesthesia
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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.
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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.
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Int J Obstet Anesth · Jan 2013
Intrathecal morphine 100 and 200 μg for post-cesarean delivery analgesia: a trade-off between analgesic efficacy and side effects.
Intrathecal morphine is highly effective for post-cesarean analgesia; however, the optimal dose is yet to be established. The aim of this study was to compare analgesia and side effects after a change in institutional practice to give 200 μg rather than 100 μg. ⋯ Intrathecal morphine 200 μg provided better analgesia but with more nausea compared with morphine 100 μg. Our results can be used to help guide intrathecal morphine dosing in cesarean delivery based on patient preference for analgesia versus side effects.
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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.