International journal of obstetric anesthesia
-
Int J Obstet Anesth · May 2014
The incidence and management of inability to advance Arrow FlexTip Plus® epidural catheters in obstetric patients.
Difficulty advancing epidural catheters is troublesome to obstetric anesthesiologists. Flexible epidural catheters have been shown to reduce paresthesiae and intravascular catheter placement in parturients, but the cause of inability to advance these catheters past the epidural needle tip remains undefined. Specifically, its incidence and effective management strategies have not been described. ⋯ Inability to advance Arrow FlexTip Plus® epidural catheters was relatively common (4.5%) and occurred despite confidence in obtaining loss of resistance. Injecting saline may be corrective and appears to have little disadvantage. However, removing the needle and performing a new placement was the most successful corrective maneuver.
-
Int J Obstet Anesth · May 2014
Observational StudyThe effect of antenatal anaesthetic consultation on maternal decision-making, anxiety level and risk perception in obese pregnant women.
Obese parturients are recognised as high risk and an antenatal anaesthetic consultation is recommended. The potential positive and negative effects of this consultation have not been investigated. This prospective observational study aimed to determine if antenatal anaesthetic consultation affects decisional conflict, anxiety scores or risk perception in obese women planning vaginal delivery. ⋯ Our results support the current practice of referral of obese parturients for anaesthetic consultation, but demonstrate that most women remain unaware of the risks of obesity in pregnancy despite anaesthetic consultation.
-
Int J Obstet Anesth · May 2014
Relaxant effects of metoclopramide and magnesium sulfate on isolated pregnant myometrium: an in vitro study.
Metoclopramide and magnesium sulfate are extensively used agents in obstetrics. In this study, the relaxant properties of metoclopramide and magnesium sulfate on pregnant myometrium, together with the possible reversing influences of oxytocin and cabergoline (a dopamine D2 receptor agonist), were investigated. ⋯ Both magnesium sulfate and metoclopramide relaxed myometrial contractions, and exhibited different responses to subsequent oxytocin treatment. The relaxant mechanism of metoclopramide may be via blockade of dopamine D2 receptor, which requires further investigation.
-
Int J Obstet Anesth · May 2014
Case ReportsSciatic nerve ischaemia after iliac artery occlusion balloon catheter placement for placenta percreta.
Placenta percreta is a complex obstetric condition and a cause of life-threatening peripartum haemorrhage. National guidelines advise preoperative placement of internal iliac artery occlusion balloon catheters in such cases to reduce haemorrhage, avoid caesarean hysterectomy and preserve fertility. ⋯ Presentation of ischaemic nerve injury attributable to iliac artery thrombosis secondary to the presence of an occlusion balloon catheter is as yet unreported. Awareness of this possible complication and local unit guidelines may allow early detection and treatment.