International journal of obstetric anesthesia
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The Gerard W. Ostheimer lecture is delivered every year at the annual meeting of the Society for Obstetric Anesthesia and Perinatology. The lecture aims to provide the anesthesiologist who provides obstetric anesthesia care with a review of the most relevant articles that were published in the preceding calendar year. This article highlights the literature published in 2017 related to maternal mortality, maternal cardiac arrest, cesarean delivery and labor analgesia.
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Int J Obstet Anesth · May 2019
Case ReportsSyncope after administration of epidural analgesia in an obstetric patient with a vagus nerve stimulator.
Vagus nerve stimulation (VNS) is an adjunctive therapy for medically refractory epilepsy and depression. Vagus nerve stimulation is generally well-tolerated, but cardiac arrhythmias or asystole are rare complications that have been reported. ⋯ These resolved after deactivating the device. This is the first report of a suspected arrhythmia during VNS in the setting of epidural analgesia.
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Int J Obstet Anesth · May 2019
Massive hemorrhage protocol activation in obstetrics: a 5-year quality performance review.
A structured approach to hemorrhagic emergencies in obstetrics has gained popularity with the implementation of massive hemorrhage protocols. The trauma literature suggests that routine quality reviews should be in place to improve patient outcomes. The aim of this study was to develop quality indicators and assess compliance by the clinical team. ⋯ Suboptimal compliance was found in multiple areas, which may be attributable to the low frequency of activation of our massive haemorrhage protocol in obstetrics. The quality targets identified in this report can act as a basis for other institutions developing quality indicators to evaluate performance.
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Int J Obstet Anesth · May 2019
A 10-year update: national survey questionnaire of obstetric anesthesia units in Israel.
This nationwide survey was conducted to provide data about the obstetric anesthesia services in Israeli labor and delivery units in 2016. ⋯ No new labor units have opened since 2005, despite huge increases in delivery volume in many units. These units manage increased numbers of epidurals and cesarean deliveries. Use of intrathecal morphine for spinal anesthesia has become more widespread. Future efforts should focus on availability of emergency equipment, separate obstetric anesthesia staffing, and establishing emergency protocols.
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Int J Obstet Anesth · May 2019
Case ReportsHow low did we go? A case report of unexpected thrombocytopenia.
We report the case of a normotensive 31-year-old parturient who received combined spinal-epidural analgesia for early labor, and who was then found to have an unexpectedly low platelet count (25 000/μL) with elevated liver enzymes, but without alterations in blood pressure.