International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2020
ReviewGastric point-of-care ultrasound (PoCUS) during pregnancy and the postpartum period: a systematic review.
Personalised risk assessment of the likelihood of pulmonary aspiration is recommended for pregnant women undergoing general anaesthesia and gastric point-of-care ultrasound (PoCUS) may help to achieve this. Traditionally, risk assessment is based upon adherence to fasting times, but gastric emptying may vary during pregnancy and surgery often needs to be expedited. We systematically reviewed the evidence for gastric PoCUS up to August 2018 in pregnant and postpartum women to determine whether it can identify and quantify stomach contents, provide aspiration risk assessment via qualitative or quantitative means, and determine how gastric emptying is affected by pregnancy. ⋯ Validated methods to quantify stomach volumes are available, however their usefulness is currently restricted to research. Gastric PoCUS also provides evidence that gastric emptying of ingested food is delayed by term pregnancy, labour and during the early postpartum period. However, the passage of fluids through the stomach appears unaffected throughout the peripartum period.
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Int J Obstet Anesth · Nov 2020
Association of renin-angiotensin-aldosterone system genetic polymorphisms with maternal hypotension during spinal anaesthesia for caesarean delivery - a retrospective cohort study.
Unless prevented, hypotension occurs in up to 80% of normotensive women undergoing spinal anaesthesia for caesarean delivery. Renin-angiotensin-aldosterone system genetic polymorphisms have been associated with hypertensive disease, but few studies investigated effects on blood pressure regulation under spinal anaesthesia. We postulated that these polymorphisms increased vasodilation and maternal hypotension during spinal anaesthesia. ⋯ AC/CC genotypes of AT1R (A1166C) polymorphism were associated with maternal hypotension under spinal anaesthesia for caesarean delivery. An association with cardiovascular indices and high-risk parturients should be examined.
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Int J Obstet Anesth · Nov 2020
Patient and procedural risk factors for increased postoperative pain after cesarean delivery under neuraxial anesthesia: a retrospective study.
There is significant interindividual variability in pain experienced after cesarean delivery. The goal of this study was to identify risk factors for increased postoperative pain in women undergoing cesarean delivery under neuraxial anesthesia with neuraxial morphine. ⋯ Certain patient and procedural factors were associated with higher levels of reported postoperative pain. Patients with those factors may require a more targeted analgesic strategy for post-cesarean delivery pain control.
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Int J Obstet Anesth · Nov 2020
Case ReportsSpiral electrode for continuous fetal heart rate monitoring during in-utero myelomeningocele repair.
Continuous fetal hemodynamic monitoring during in-utero surgery is desirable, but it is often not feasible without intermittent interruption. We report the use of a fetal spiral electrode for continuous heart rate monitoring during fetal myelomeningocele repair. ⋯ Using the Bland-Altman approach, the mean (SD) difference between measurements was 1.8 (3.5) beats per minute with limits of agreement of -5.3 to 8.8 beats per minute. This case illuminates a potential role for a fetal spiral electrode as a real-time adjunct in fetal interventions.
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Int J Obstet Anesth · Nov 2020
Case ReportsCesarean delivery in a parturient with a left ventricular assist device.
Left ventricular assist devices are implanted pumps designed to treat patients with heart failure, and in some cases, to be a bridge to transplantation for patients who qualify. The preconception presence of a left ventricular assist device is a relative contraindication to pregnancy. ⋯ Her medical history was significant for the presence of a left ventricular assist device, inserted due to heart failure associated with polysubstance abuse. To our knowledge, this is the first description of successful cesarean delivery under neuraxial anesthesia of a parturient with a left ventricular assist device.