International journal of obstetric anesthesia
-
Int J Obstet Anesth · Nov 2018
Experimental validation of the CompuFlo® epidural controlled system to identify the epidural space and its clinical use in difficult obstetric cases.
This prospective study was designed to validate the CompuFlo® device and to assess its use in difficult epidural placement. ⋯ In all cases epidural analgesia was successful and no complications were noted. There was a good correlation between the operator's feelings and the delta of pressure recorded by the CompuFlo®, for both identification of the ligamentum flavum and of the epidural space (Rho = 0.79; tau = 0.67). In the second part of the study, all the difficult blocks performed with the CompuFlo® were successful after a single attempt. The pressure curves of false loss-of-resistance were significantly different from the true loss-of-resistance (P <0.0001) DISCUSSION: CompuFlo® was validated as a tool to identify the epidural space. It may also assist trainees in successful epidural placement in difficult cases.
-
Int J Obstet Anesth · Nov 2018
Randomized Controlled TrialAcupuncture for reducing pruritus induced by intrathecal morphine at elective cesarean delivery: a placebo-controlled, randomized, double-blind trial.
Intrathecal morphine is a standard postoperative analgesic administered after cesarean delivery, but frequently causes pruritus. Acupuncture reportedly resolves refractory pruritus in certain patients. The aim of the study was to investigate the effectiveness of acupuncture in preventing pruritus induced by intrathecal morphine. ⋯ Preoperatively administered acupuncture using press needles did not decrease intrathecal morphine-induced pruritus or the requirement for treatment.
-
Int J Obstet Anesth · Nov 2018
Case ReportsPostpartum hemoptysis as presenting sign of longstanding vasculitis.
We present the case of a 26-year-old postpartum patient who presented with an episode of desaturation and hemoptysis on postpartum day three after an uncomplicated spontaneous vaginal delivery. The patient came to our attention in the postpartum area after she experienced massive hemoptysis and we were called by the obstetric team. ⋯ Her intensive care unit course was complicated by acute respiratory distress syndrome, acute kidney injury and a pulmonary embolism, but she recovered well and was discharged on postpartum day 23. This report describes a rare case of medium vessel vasculitis diagnosed in the peripartum period, and describes the diagnostic dilemmas underlying making a rare diagnosis, and the difficulties initiating appropriate therapy in a postpartum patient.
-
Int J Obstet Anesth · Nov 2018
Case ReportsAnesthetic management for cesarean delivery in a patient with uncorrected pulmonary atresia, ventricular septal defect and major aortopulmonary collateral arteries.
Pulmonary atresia witha ventricular septal defect and major aortopulmonary collateral arteries is an extremely rare congenital disorder characterized by a high risk of maternal mortality. We present the case of a 24-year-old primigravid woman with uncorrected pulmonary atresia, ventricular septal defect and major aortopulmonary collateral arterieswho presented at 35+5 weeks' gestation. Based on the pathophysiology of the congenital cardiac lesion, cesarean delivery was performed under epidural anesthesia under management by a multidisciplinary team. This report highlights the anesthesia management of a rare uncorrected congenital cardiac lesion for cesarean delivery.