International journal of obstetric anesthesia
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We conducted a retrospective review of obstetric patients admitted to the intensive care unit at Al-Ain hospital during period January 1(st) 1997 to December 31(st) 2002, in order to identify the indications for admission and the outcome. A total of 60 patients were admitted during the six years. The frequency of admission was 2.6 per 1000 deliveries and obstetric patients represented 2.4% of all ICU admissions. ⋯ The mean APACHE II score and duration of stay were significantly higher in these patients. There were two deaths, representing 3.3% of obstetric intensive care unit admissions. Our findings highlight the need for establishing a high dependency unit to avoid unnecessary admission to the intensive care unit and to ensure proper management.
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Int J Obstet Anesth · Apr 2004
Comparative StudyIn vitro evidence of gender-related heparin resistance.
Coagulability varies among men, women, and pregnant women, along a spectrum where the blood of men is the least and that of pregnant women the most coagulable. The effects of differences in coagulation status on the action of heparin cannot be measured by specific laboratory tests such as aPTT or anti-Factor Xa assay. Thromboelastography which measures whole blood coagulation can assess the effect of heparin against differing backgrounds of coagulation. ⋯ Across the subject groups, from men to pregnant women, increasing coagulability was seen, with shortening of r and k (P < 0.04), and increasing angle and MA (P < 0.0001). A relationship between gender and heparin was significant for r and k (P < 0.02) but not for angle and MA. This result assists the case against a one-size-fits-all approach to policies on heparinisation.
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Int J Obstet Anesth · Apr 2004
Case ReportsEpidural anaesthesia for caesarean section in a patient with quadriplegia and autonomic hyperreflexia.
The anaesthetic management of a pregnant quadriplegic woman with a history of autonomic hyperreflexia is discussed. Autonomic hyperreflexia is a life-threatening complication of high spinal cord transection, for which labour is a well known stimulus. It can lead to uncontrolled hypertension. We discuss the anaesthetic considerations in planning the care of this patient, who was managed for elective caesarean section and post partum hypertension with epidural anaesthesia.
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Int J Obstet Anesth · Apr 2004
Consent for regional anaesthesia in the United Kingdom: what is material risk?
Legal principles that apply to the process of informed consent have changed in recent years. Patients should now be given the information that they wish to receive, not the information that health professionals may consider reasonable for them. In obstetric practice informed consent is especially important as young, fit patients may request and receive non-essential but potentially life-threatening interventions. ⋯ Despite the availability of information for patients from sources such as the Obstetric Anaesthetists' Association and the National Electronic Library for Health, there remains little consensus amongst anaesthetists about what information to provide. Frequently some complications that patients would consider important are not discussed. Changing legal and public expectations demand that we adapt our current practice and improve the accuracy and timing of information provided.
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Int J Obstet Anesth · Apr 2004
Comment Letter Case ReportsMore failed spinal anesthetics with hyperbaric bupivacaine.