International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2020
Comparative StudyIntra-operative ketorolac 15 mg versus 30 mg for analgesia following cesarean delivery: a retrospective study.
Ketorolac is a nonsteroidal anti-inflammatory drug used as part of multimodal analgesia in women undergoing cesarean delivery. The lowest effective dose of ketorolac that best optimizes analgesia without increasing side effects is unclear. We performed this retrospective study to compare the analgesic efficacy of 15 mg or 30 mg ketorolac administered intra-operatively to our obstetric population. ⋯ There was no difference in opioid use between patients receiving either a 15 mg or a 30 mg dose of ketorolac given intra-operatively for postoperative analgesia following cesarean delivery.
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Int J Obstet Anesth · Nov 2020
Anesthetic management of women with heart failure during pregnancy - a retrospective cohort study.
The incidence of heart failure among pregnant women with pre-existing cardiac disease is quoted as 13%, with 10% requiring hospitalization. There is limited literature on heart failure in the pregnant population. The study objective was to describe the etiology and management of women hospitalized in our institution for heart failure during pregnancy. ⋯ The incidence of heart failure was 0.13% (1:776 deliveries). Pre-eclampsia was the leading cause but may have been historically under-acknowledged. Anesthetic and obstetrical decisions were tailored by means of multidisciplinary input, with cesarean delivery and regional anesthesia used in the majority. The postpartum period warrants heightened attention for these patients.
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Int J Obstet Anesth · Nov 2020
Observational StudyThe crossed-leg position increases the dimensions within the acoustic target window for neuraxial needle placement in term pregnancy: a prospective observational study.
Neuraxial anesthesia in obstetric patients may be difficult to achieve due to anatomical changes in pregnancy. The crossed-leg position may help in optimizing patient position. We prospectively evaluated the utility of the crossed-leg position compared with a standard position using ultrasound measurements. ⋯ We demonstrated a significant increase in the sonographically measured lengths of the posterior longitudinal ligament, ligamentum flavum and interlaminar distance in the crossed-leg position when compared with the standard position. Both positions were comfortable. Further studies should explore whether these findings translate clinically into easier needle placement in the crossed-leg position.
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Int J Obstet Anesth · Nov 2020
Observational StudyRelationship between postpartum mood disorder and birth experience: a prospective observational study.
This study aims to investigate the relationship between the birth experience and the risk of developing postpartum depression or post-traumatic stress disorder. ⋯ Depression and post-traumatic stress symptoms either persisted or had new onset at three months postpartum. Mental health screening and postpartum follow-up after six weeks should be considered in high-risk patients who have a history of psychopathology, nulliparity, or undergo operative management of postpartum hemorrhage.
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Int J Obstet Anesth · Nov 2020
Case ReportsCongenital complete heart block in the setting of severe pre-eclampsia requiring urgent Cesarean section.
Congenital complete heart block is a rare phenomenon that may be discovered during pregnancy in patients who were previously asymptomatic. Peripartum management of these patients mandates a multidisciplinary approach with careful planning regarding indications for pacing, appropriate anesthetic technique, and contingency planning. Approaches to anesthetic management for congenital complete heart block have been described, but management in association with severe pre-eclampsia has not been reported. We describe the anesthetic management of a parturient with complete heart block who presented with severe pre-eclampsia requiring urgent cesarean section.