International journal of obstetric anesthesia
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Int J Obstet Anesth · Feb 2018
Review Case ReportsAnaesthetic management of pregnant patients with cardiac implantable electronic devices: case reports and review.
Heart disease is a leading cause of maternal mortality and morbidity. Pregnant women with structural, conduction or degenerative cardiac disease who require rhythm control or who are at high risk of sudden cardiac death may carry a cardiac implantable electronic device or may occasionally require the insertion of one during their pregnancy. These women are now encountered more frequently in clinical practice, and it is essential that a multidisciplinary approach, beginning from the early antenatal phase, be adopted in their counselling and management. ⋯ Of particular importance is the potential adverse effect of electromagnetic interference, which may cause device malfunction or damage, and the precautions required to reduce this risk. The ultimate goal in the management of this patient subgroup is to minimise the disruption to cardiovascular physiology that may occur near the time of labour and delivery and to control the factors that impact on device integrity and function. We present the ante- and peripartum management of two pregnant women with an implantable cardioverter-defibrillator, followed by a review and update of the anaesthetic management of parturients with cardiac implantable electronic devices.
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Int J Obstet Anesth · Feb 2018
Review Case ReportsThe need for an epidural "window of opportunity" in pregnant women with a lumbar tattoo.
Pregnant women with lower back tattoos who wish to have an epidural placed during labour pose a dilemma to anesthesiologists. Clear guidelines have not been established. We reviewed the epidural risks in pregnant women with low back tattoos and have suggested precautionary measures to minimise them. Given the limited information available, and in the absence of a clear evidence-based medical contraindication, an epidural technique should not be excluded in those women with a lower back tattoo.