International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2016
ReviewThe value of decision tree analysis in planning anaesthetic care in obstetrics.
The use of decision tree analysis is discussed in the context of the anaesthetic and obstetric management of a young pregnant woman with joint hypermobility syndrome with a history of insensitivity to local anaesthesia and a previous difficult intubation due to a tongue tumour. The multidisciplinary clinical decision process resulted in the woman being delivered without complication by elective caesarean section under general anaesthesia after an awake fibreoptic intubation. The decision process used is reviewed and compared retrospectively to a decision tree analytical approach. The benefits and limitations of using decision tree analysis are reviewed and its application in obstetric anaesthesia is discussed.
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Int J Obstet Anesth · Aug 2016
Case ReportsUse of Doppler ultrasound in the management of uteroplacental perfusion during cardiopulmonary bypass in pregnancy.
Cardiopulmonary bypass, the extreme of non-obstetric surgery during pregnancy, presents unique challenges to minimize maternal and fetal risk. We present our experience with a woman who was diagnosed with a left atrial myxoma following an ischemic cerebrovascular accident. ⋯ We recommend using intermittent Doppler ultrasound as a non-invasive real-time assessment of uteroplacental perfusion during non-obstetric surgery in pregnancy. Monitoring of perfusion facilitates active feedback for appropriate in utero resuscitation in these cases.
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Int J Obstet Anesth · Aug 2016
Meta Analysis Comparative StudyDuration of motor block with intrathecal ropivacaine versus bupivacaine for caesarean section: a meta-analysis.
When used for Caesarean section, intrathecal ropivacaine results in faster recovery of motor block but no difference in onset, sensory duration or GA conversion when compared to bupivacaine.
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Int J Obstet Anesth · Aug 2016
Comparative StudyEphedrine versus ondansetron in the prevention of hypotension during cesarean delivery: a randomized, double-blind, placebo-controlled trial.
Maternal hypotension is common after spinal anesthesia for cesarean delivery. We compared the effects of prophylactic ephedrine with ondansetron on post-spinal blood pressure. ⋯ There was no significant difference in maternal blood pressure in women administered prophylactic ephedrine or ondansetron after spinal anesthesia for cesarean delivery compared with placebo. Ephedrine reduced the proportion of patients requiring a rescue vasoconstrictor before delivery.