International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2019
Observational StudyBaseline parameters for rotational thromboelastometry (ROTEM®) in healthy women undergoing elective caesarean delivery: a prospective observational study in Australia.
Formal reference ranges for rotational thromboelastometry (ROTEM®) in pregnancy have not been obtained in the recommended minimum sample size of 120. This prospective observational study aimed to establish baseline parameters in an Australian population of women undergoing elective caesarean delivery. The secondary aim was to compare these reference ranges with those from prior studies and the manufacturer. ⋯ ROTEM® reference ranges for women with uncomplicated term pregnancies were reported as per the International Federation of Clinical Chemistry. The FIBTEM MCF and FIBTEM/EXTEM/INTEM amplitudes were higher in comparison to the manufacturer's reference ranges for the non-obstetric population. The EXTEM CT was shorter than the non-obstetric reference ranges. These ranges show an increase in coagulability during normal pregnancy compared to the non-pregnant reference ranges.
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Int J Obstet Anesth · May 2019
Case ReportsAnaesthetic management for caesarean section of a parturient with a known difficult airway and closed spinal dysraphism.
Many anaesthetists consider patients with existing neurological deficits, untreated spinal pathology or those having undergone major spinal intervention to be precluded from undergoing neuraxial anaesthesia. While this is partly rooted in fears of litigation there is also a lack of consensus of the best practice in the anaesthetic management of these patients. ⋯ She successfully underwent delivery under neuraxial blockade for the delivery of her fourth child. We believe that by undergoing a thorough multidisciplinary clinical evaluation, including the extensive use of neuroimaging and ultrasound, it may be possible to plan and perform safe neuraxial anaesthesia.