International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2016
Programmed intermittent epidural boluses for maintenance of labor analgesia: an impact study.
The aim of this impact study was to compare the analgesic efficacy and side effect profile of programmed intermittent epidural boluses (PIEB)+patient-controlled epidural analgesia (PCEA) to continuous epidural infusion (CEI)+PCEA for maintenance labor analgesia after the introduction of PIEB at our institution. ⋯ Using PIEB compared to CEI as the background maintenance epidural analgesia method in conjunction with PCEA reduced the number of women requiring clinician rescue boluses while providing comparable labor analgesia. The findings of this clinical care impact study confirm the results of randomized controlled studies and suggest PIEB may be a preferable technique to CEI for the maintenance of labor analgesia.
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Int J Obstet Anesth · May 2016
Review Case ReportsHeparin-induced thrombocytopenia in pregnancy: an interdisciplinary challenge-a case report and literature review.
Heparin-induced thrombocytopenia is a serious adverse event of anticoagulation with a high risk of thromboembolic complications. As a consequence, anticoagulants other than heparins must be administered. ⋯ Impaired coagulation bears the risk of adverse events following neuraxial procedures and of peripartum hemorrhage. We describe the case of heparin-induced thrombocytopenia in a 29-year-old pregnant woman at 27weeks of gestation with severe valvular heart disease.
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Int J Obstet Anesth · May 2016
ReviewThe 2016 Hughes Lecture: What's new in maternal morbidity and mortality?
Each year, the Board of Directors of the Society for Obstetric Anesthesia and Perinatology selects an individual to review a given year's published obstetric anesthesiology literature. This individual then produces a syllabus of the year's most influential publications, delivers the Ostheimer Lecture at the Society's annual meeting, the Hughes Lecture at the following year's Sol Shnider meeting, and writes corresponding review articles. ⋯ This is followed by a discussion of specific coexisting diseases and specific causes of severe maternal mortality. The review ends with a discussion of worldwide maternal mortality and the 2014 publications that examined the successes and the shortfalls in the work to make childbirth safe for women throughout the entire world.
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Int J Obstet Anesth · May 2016
Comparative StudyDifferences in lumbar dural sac dimension in supine and lateral positions in late pregnancy: a magnetic resonance imaging study.
This study was designed to quantitatively investigate differences in lumbar dural sac dimensions between the lateral and supine positions in late pregnancy. ⋯ The axial section area and the transversal maximum diameter of the dural sac in the lumbar area are reduced in the supine compared with the lateral position in late pregnancy.
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Int J Obstet Anesth · May 2016
Case ReportsRefractory status epilepticus after inadvertent intrathecal injection of tranexamic acid treated by magnesium sulfate.
We present a case of accidental injection of tranexamic acid during spinal anesthesia for an elective cesarean delivery. Immediately following intrathecal injection of 2mL of solution, the patient complained of severe back pain, followed by muscle spasm and tetany. As there was no evidence of spinal block, the medications given were checked and a 'used' ampoule of tranexamic acid was found on the spinal tray. ⋯ Unfortunately, on postoperative day three the patient died from cardiopulmonary arrest after an oxygen supply failure that was not associated with the initial event. This report underlines the importance of double-checking medications before injection in order to avoid a drug error. As well, it suggests that magnesium sulfate may be useful in stopping seizures caused by the intrathecal injection of tranexamic acid.