International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2013
The impact of spinal anaesthesia for caesarean delivery on coagulation assessed by thromboelastography.
Pregnancy and puerperium are associated with a hypercoagulable state. The aim of the study was to assess the impact of spinal anaesthesia on coagulation using thromboelastography in healthy term pregnant women undergoing elective caesarean delivery. ⋯ In women undergoing caesarean delivery under spinal anaesthesia, enhanced coagulation thromboelastography parameters were observed in blood collected from hand veins. No changes were detected in the majority of parameters collected from the foot. Spinal anaesthesia has different effects on coagulation parameters in the hand and foot in pregnant women undergoing caesarean delivery.
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Int J Obstet Anesth · Jan 2013
Randomized Controlled TrialA dose-response study of remifentanil for attenuation of the hypertensive response to laryngoscopy and tracheal intubation in severely preeclamptic women undergoing caesarean delivery under general anaesthesia.
Remifentanil is known to attenuate the cardiovascular responses to tracheal intubation. We determined effective doses (ED(50)/ED(95)) of remifentanil to prevent the pressor response to tracheal intubation in patients with severe preeclampsia. ⋯ The ED(95) of remifentanil for attenuating the hypertensive response to tracheal intubation during induction of anaesthesia in severely preeclamptic patients undergoing caesarean delivery under general anaesthesia was 1.34 μg/kg.
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Int J Obstet Anesth · Jan 2013
Case ReportsHyperfibrinolysis diagnosed by rotational thromboelastometry in a case of suspected amniotic fluid embolism.
Rotational thromboelastometry is a viscoelastomeric, point-of-care method for testing haemostasis in whole blood which can be visualised rapidly, in real time, in the operating theatre. Advantages over traditional coagulation tests relate to the rapid feedback of results and the ability to visualise hyperfibrinolysis. We present a case of suspected amniotic fluid embolism that presented with sudden respiratory arrest associated with haemodynamic compromise during a non-elective caesarean delivery. ⋯ Rotational thromboelastometry showed hyperfibrinolysis and hypofibrinogenaemia, which allowed targeted coagulation factor replacement therapy and the use of tranexamic acid. Hyperfibrinolysis may be a contributor to the coagulopathy associated with amniotic fluid embolism but has been infrequently reported, perhaps due to limited diagnosis with traditional coagulation tests. Treatment of the coagulopathy associated with a suspected amniotic fluid embolism with antifibrinolytic agents may deserve greater consideration.
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Int J Obstet Anesth · Jan 2013
Case ReportsElectrical impedance tomography may optimize ventilation in a postpartum woman with respiratory failure.
Amniotic fluid embolism is a rare peripartum complication with the sudden onset of haemodynamic instability, respiratory failure and coagulopathy during labour or soon after delivery. A 31-year-old woman with amniotic fluid embolism was treated with vasopressors, inotropes, intravenous fluid, tranexamic acid and ventilatory support. Assessment of respiratory impairment was made using conventional chest X-ray, computed tomography and electrical impedance tomography. The potential for electrical impedance tomography to improve monitoring and guide respiratory therapy is explored.