International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2013
ReviewInteractive technology in obstetric anaesthesia and analgesia: exploring seamless solutions to jagged problems.
Perioperative care often involves treating rapid changes in a patient's physiological profile that requires timely intervention by anaesthetists. Interactive technology and closed-loop systems are currently developed in obstetric anaesthesia and analgesia for maintaining parameters during caesarean section and epidural analgesia. ⋯ The components of an interactive system such as the input sensor or device, microprocessor-based control unit and the effector are introduced. Developments in continuous, non-invasive blood pressure monitoring, control algorithms and smart pump technology would help to redefine how technology can assist obstetric anaesthetists to provide better care and improve clinical outcomes for pregnant women.
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Int J Obstet Anesth · Nov 2013
Randomized Controlled TrialAnalgesic effects of intrathecal tramadol in patients undergoing caesarean section: a randomised, double-blind study.
Intrathecal tramadol combined with local anaesthetics has been used for postoperative analgesia following lower abdominal and perineal surgery. The present study evaluated the effect of intrathecal tramadol on spinal block characteristics and neonatal outcome after elective caesarean section. ⋯ Compared to intrathecal fentanyl 10 μg, tramadol 10 mg, as an adjunct to bupivacaine for subarachnoid block for caesarean section, showed a longer duration of analgesia with a reduced incidence of shivering.
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Int J Obstet Anesth · Nov 2013
Peak plasma anti-Xa levels after first and third doses of enoxaparin in women receiving weight-based thromboprophylaxis following caesarean section: a prospective cohort study.
Women undergoing caesarean section are at higher risk for thromboembolic complications following delivery than other parturients. The aim of this study was to determine whether higher doses of enoxaparin based on body weight are safe and more likely to achieve plasma anti-Xa levels within the accepted thromboprophylactic range. ⋯ The majority of women receiving weight-based enoxaparin thromboprophylaxis following caesarean section achieved plasma anti-Xa levels within the putative thromboprophylactic range. No woman achieved levels associated with an increased risk of bleeding (>0.8 IU/mL). These findings provide a safety basis for a large prospective study using this regimen.
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Int J Obstet Anesth · Nov 2013
Case ReportsDural ectasia in Marfan's syndrome: magnetic resonance imaging appearances and anaesthetic experience of three deliveries.
Neuraxial anaesthetic techniques are considered useful to minimise haemodynamic stress during labour. In Marfan's syndrome, connective tissue abnormalities not only affect the thoracic aorta but also predispose to dural ectasia. ⋯ We consider that epidural analgesia and anaesthesia are a safe and pragmatic solution for labour and delivery. Lumbo-sacral magnetic resonance imaging at presentation will define dural ectasia and assist in management.
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There is no globally-accepted definition of epidural failure; this leads to wide differences in reported failure rates. A definition of epidural failure was standardised using a modified Delphi approach involving senior obstetric anaesthetists in the UK. Using this definition, epidural failures were calculated in our institution. ⋯ The study identified epidural failure rates using a standardised definition. This information could be used to guide training decisions and to support doctors during their training period.