International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2017
Randomized Controlled Trial Multicenter StudyNeonatal effects after vasopressor during spinal anesthesia for cesarean section: a multicenter, randomized controlled trial.
Placental transfer of ephedrine causes fetal effects when compared with phenylephrine. This study compared their drug effects on neonatal parameters after cesarean delivery under spinal anesthesia. ⋯ Ephedrine, compared to phenylephrine as a vasopressor during cesarean delivery, was associated with higher neonatal heart rate in the early post-birth period, but without a significant difference in clinical outcomes in uncomplicated pregnancies.
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Int J Obstet Anesth · Nov 2017
Observational StudyIntravenous dexmedetomidine for cesarean delivery and its concentration in colostrum.
Dexmedetomidine is a sedative agent with high α2-adrenoreceptor selectivity. We investigated intravenous dexmedetomidine administration during scheduled cesarean delivery under neuraxial anesthesia; and its concentration in the colostrum. ⋯ The dexmedetomidine milk-to-plasma ratio did not exceed 1 in any participant, and the relative infant dose was very low. Maternal sedation using dexmedetomidine is unlikely to be harmful for the infant.
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Int J Obstet Anesth · Nov 2017
Case ReportsEthical and medical management of a pregnant woman with brain stem death resulting in delivery of a healthy child and organ donation.
Maternal brain death during pregnancy remains an exceedingly complex situation that requires not only a well-considered medical management plan, but also careful decision-making in a legally and ethically delicate situation. Management of brain dead pregnant patients needs to adhere to special strategies that support the mother in a way that she can deliver a viable and healthy child. Brain death in pregnant women is very rare, with only a few published cases. ⋯ The patient received continuous hormone substitution therapy, fetal monitoring and extrinsic regulation of maternal homeostasis over 64days. After delivery, the final diagnosis of brain death was established through multi-slice computerized tomography pan-angiography. This challenging case discusses ethical and medical circumstances arising from a diagnosis of maternal brain death, while showing that prolongation of somatic life support in a multidisciplinary setting can result in a successful pregnancy outcome.
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Int J Obstet Anesth · Nov 2017
A prospective study of post-cesarean delivery hypoxia after spinal anesthesia with intrathecal morphine 150μg.
Delayed respiratory depression is a feared complication of intrathecal morphine in patients undergoing cesarean delivery. The incidence, timing and risk factors for hypoxia in this population are not known. ⋯ Mild hypoxemia occurred frequently in women receiving intrathecal morphine 150μg for post-cesarean analgesia. Desaturations were observed most frequently 4-8hours after administration of intrathecal morphine. Obesity and a positive Berlin Questionnaire were risk factors for hypoxemic events.