International journal of obstetric anesthesia
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Int J Obstet Anesth · Feb 2019
Observational StudyUterotonic drug usage in Canada: a snapshot of the practice in obstetric units of university-affiliated hospitals.
The objective of this study was to determine the pattern of uterotonic drug usage in obstetric units of university-affiliated hospitals in Canada. ⋯ There is a lack of a unified approach to the use of uterotonic drugs for postpartum hemorrhage management in Canada. To improve the management of postpartum hemorrhage due to uterine atony, an evidence-based approach to usage and consensus between obstetricians and anesthesiologists is warranted.
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Int J Obstet Anesth · Feb 2019
Randomized Controlled TrialProphylactic infusion of phenylephrine is effective in attenuating the decrease in regional cerebral blood volume and oxygenation during spinal anesthesia for cesarean section.
Hypotension induced by spinal anesthesia for cesarean section causes a decrease in maternal regional cerebral blood volume and oxygenation. We used near-infrared spectroscopy to determine whether prophylactic infusion of phenylephrine attenuates these decreases. ⋯ Prophylactic infusion of phenylephrine, especially at 25 µg/min, can effectively suppress decreases in regional cerebral blood volume and regional cerebral blood oxygenation after induction of spinal anesthesia for cesarean section.
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Int J Obstet Anesth · Feb 2019
Review Comparative StudyIs training in obstetric critical care adequate? An international comparison.
Obstetric critical care is an emerging discipline which cuts across speciality boundaries. We have analysed the training curricula in the three major specialities (obstetrics, anaesthesia and intensive care medicine) likely to be involved in the care of the critically-ill obstetric patient, to assess whether it is adequate to ensure effective training on this subject.
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Int J Obstet Anesth · Feb 2019
ReviewMaternal critical care in resource-limited settings. Narrative review.
Maternal critical care reflects interdisciplinary care in any hospital area according to the severity of illness of the pregnant woman. The admission rate to intensive care units is below 1% (0.08-0.76%) of deliveries in high-income countries, and ranges from 0.13% to 4.6% in low- and middle-income countries. Mortality in these patients is high and varies from 0% to 4.9% of admissions in high-income countries, and from 2% to 43.6% in low- and middle-income countries. ⋯ Our aims were to (i) propose a more practical definition of maternal critical care, (ii) discuss maternal mortality in the setting of limited accessibility of critical care units, (iii) provide some accessible tools to improve identification of obstetric patients who may become critically ill, and (iv) confront challenges in providing maternal critical care in resource-limited settings. To improve maternal critical care, training programmes should embrace modern technological educational aids and incorporate new tools and technologies that assist prediction of critical illness in the pregnant patient. The goal must be improved outcomes following early interventions, early initiation of resuscitation, and early transfer to an appropriate level of care, whenever possible.
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Int J Obstet Anesth · Feb 2019
Case ReportsAnaesthetic implications of a patient with cold-induced anaphylaxis presenting to the labour ward.
Cold contact urticaria is a well described condition, with reactions ranging from localised wheals to systemic and anaphylactic reactions. Case reports involving anaesthetic care are rare. ⋯ She subsequently had an uneventful instrumental delivery following an epidural 'top-up'. This report focuses on the anaesthetic implications of her condition.