International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 1999
Anaesthetic management of parturients with the antiphospholipid syndrome: a review of 27 cases.
A description of antiphospholipid syndrome (APS) and associated maternal and fetal complications is presented along with a review of the management at National Women's Hospital (NWH), Auckland, of 27 pregnancies complicated by APS. Because the obstetric outcome for parturients with APS continues to improve, anaesthetists are more likely to become involved in their management. It is recommended that policies and protocols are implemented to avoid unnecessary denial of regional anaesthesia arising from confusion about any parturients anticoagulation status.
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Int J Obstet Anesth · Oct 1999
Regional anaesthesia for multiple caesarean sections in a parturient with osteogenesis imperfecta.
We describe a 27-year-old woman with osteogenesis imperfecta who, over a period of 9 years, underwent five caesarean sections under regional anaesthesia without major complication. The first three operations were conducted under epidural and the last two under spinal anaesthesia. To our knowledge, this is the first reported case of spinal anaesthesia for caesarean section in a parturient with osteogenesis imperfecta.
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Int J Obstet Anesth · Oct 1999
Randomized Controlled Trial Clinical TrialOxford positioning technique improves haemodynamic stability and predictability of block height of spinal anaesthesia for elective caesarean section.
A novel positioning technique was tested to see whether the unpredictability of block height and haemodynamic instability during spinal anaesthesia for caesarean section could be reduced. In this 'Oxford' position, the woman is placed left lateral with an inflated bag under the shoulder and pillows supporting the head. Following spinal injection the woman is turned to an identical right lateral position. ⋯ Block height was more variable in group S than in group O (f test, P = 0.001). Blood pressure decreased by a greater amount initially: group S women required more ephedrine (15.5 +/- 12.9 versus 9.2 +/- 7.7 mg, t test, P = 0.03). Block height with spinal anaesthesia for caesarean section is more predictable and haemodynamically stable if the Oxford position is used whilst anaesthesia develops.
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We review the evidence base for fluid management in pre-eclampsia. Current understanding of the relevant pathophysiology and the possible impact of styles of fluid management on maternal and fetal outcome are presented. There is little evidence upon which to base the management of fluid balance in pre-eclampsia. ⋯ Pulmonary oedema and oliguria receive particular attention. There is no evidence of long-term renal damage in pre-eclampsia, but there are strong suggestions that pulmonary oedema is linked to fluid administration. Monitoring is discussed and some principles of management are suggested