International journal of obstetric anesthesia
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Int J Obstet Anesth · Feb 2021
Randomized Controlled TrialPre-operative carbohydrate loading prior to elective caesarean delivery: a randomised controlled trial.
Women undergoing elective caesarean deliveries are fasted for long periods prior to surgery and can become catabolic. The use of pre-operative carbohydrate drinks to optimise patients ahead of major surgery is now well established. However, evidence to support this in women undergoing elective caesarean delivery is limited. ⋯ The results of this study support the introduction of carbohydrate drinks ahead of caesarean delivery to offset the effects of pre-operative fasting. However, the results may not be generalisable to all maternity units due to differences in fasting protocols.
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Int J Obstet Anesth · Feb 2021
Selection of baseline blood pressure to guide management of hypotension during spinal anaesthesia for caesarean section.
Recommendations on vasopressor management during caesarean section under spinal anaesthesia suggest maintaining systolic arterial pressure ≥90% of an accurately measured baseline value. The baseline is often taken as the first reading in the operating room. We hypothesise that this reading may not reflect an accurate baseline value. ⋯ Using the initial blood pressure reading in the operating room as the baseline value may lead to unnecessary vasopressor use and hypertension. Prospective research is required to clarify which reading represents the most accurate baseline to maintain homeostasis and reduce the hypotensive sequelae of neuraxial anaesthesia for both the mother and fetus.
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Int J Obstet Anesth · Feb 2021
Observational StudyThe influence of labor epidural analgesia on maternal, uteroplacental and fetoplacental hemodynamics in normotensive parturients: a prospective observational study.
Epidural analgesia provides sufficient analgesia during labor but can cause hypotension despite various prophylactic measures. We studied its effects on pre-placental, fetoplacental, and fetal hemodynamics using Doppler ultrasound. The primary endpoint was the pulsatility index of the umbilical artery at 30 min after establishing epidural analgesia. Secondary endpoints included maternal blood pressures and neonatal outcome data. ⋯ Pre-placental, fetoplacental and fetal hemodynamics remained stable despite a statistically significant decrease in maternal blood pressure in laboring parturients receiving epidural analgesia.