International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2018
Randomized Controlled TrialThe effect of a single intraoperative dose of intravenous dexamethasone 8 mg on post-cesarean delivery analgesia: a randomized controlled trial.
A single perioperative dose of dexamethasone has been shown to improve postoperative analgesia and reduce opioid consumption. However, this analgesic and opioid sparing effect has not been well assessed as part of a multimodal analgesic regimen in women post-cesarean delivery. ⋯ The addition of intravenous dexamethasone 8 mg to a multimodal postoperative analgesic regimen that included intrathecal morphine, in women who had a cesarean delivery under spinal anesthesia, did not reduce 24 hour postoperative opioid consumption.
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Int J Obstet Anesth · Aug 2018
Case ReportsPeripartum anaesthetic management of a patient with Brugada syndrome and myoadenylate deaminase deficiency.
Brugada syndrome is a rare electrophysiological cardiac disease which can result in serious arrhythmias and sudden cardiac death. Peripartum management is centred around avoiding arrhythmogenic drugs, including high doses of sodium channel blocking drugs such as bupivacaine. ⋯ There is evidence that myoadenylate deaminase deficiency can predispose patients to developing malignant hyperthermia when exposed to specific anaesthetic agents. We present a case of a pregnant patient with both Brugada syndrome and myoadenylate deaminase deficiency, in which analgesic and general anaesthetic options for each condition presented potentially conflicting dilemmas for the delivery of intrapartum care.
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Int J Obstet Anesth · Aug 2018
Intraperitoneal chloroprocaine is a useful adjunct to neuraxial block during cesarean delivery: a case series.
Use of intraperitoneal local anesthetic to treat intraoperative pain during cesarean delivery has not been described previously. The aim of this study was to determine if intraperitoneal chloroprocaine may be useful as an adjunct to neuraxial block in reducing the proportion of patients with severe intraoperative pain that requires conversion to general anesthesia. Intraperitoneal chloroprocaine was administered during cesarean delivery as a potential alternative, when the anesthesiologist considered performing a general anesthetic due to severe intraoperative pain. ⋯ Intraperitoneal chloroprocaine may be useful as part of a multimodal approach to managing intraoperative pain during cesarean delivery.
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Int J Obstet Anesth · Aug 2018
Letter Case ReportsProlonged neurological deficit following spinal anaesthesia.
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Int J Obstet Anesth · Aug 2018
ReviewHorner's syndrome following obstetric neuraxial blockade - a systematic review of the literature.
Horner's syndrome is a rarely reported complication of neuraxial blockade. In obstetric practice, the neurological signs of Horner's syndrome may cause anxiety amongst patients and healthcare staff, but more importantly may herald the onset of maternal hypotension. Medline, CINAHL, and EMBASE databases were searched to identify cases of Horner's syndrome following obstetric neuraxial blockade. ⋯ Patients with a persistent Horner's syndrome, or one associated with atypical features such as neck pain, should undergo a diagnostic workup including magnetic resonance angiography of the neck. The dermatomal level of neuraxial blockade, maternal and fetal well-being should be taken into account when making decisions regarding neuraxial blockade. The presence of Horner's syndrome alone should not lead to discontinuation of neuraxial blockade.