International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2018
Review Meta AnalysisThe influence of fluid management on outcomes in preeclampsia: a systematic review and meta-analysis.
The optimal fluid management strategy to ensure best outcomes in preeclamptic patients remains a controversial issue, with little evidence to support any one approach. ⋯ Data on the ideal fluid strategy in women with preeclampsia is limited, and insufficient to make any strong recommendations. Further randomised controlled studies are needed to provide more evidence for which fluid management strategies are best suited to this heterogeneous patient group.
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Int J Obstet Anesth · Nov 2017
Review Meta AnalysisIntrathecal clonidine as an adjuvant for neuraxial anaesthesia during caesarean delivery: a systematic review and meta-analysis of randomised trials.
Clonidine is used as adjuvant to local anaesthetics for spinal anaesthesia. Its potential harm and benefits have not been systematically reviewed in obstetrics, and medical regulatory authorities do not recommend its intrathecal administration. The aim of this study was to assess the safety and efficacy of intrathecal clonidine for caesarean delivery. ⋯ Clonidine is an effective and safe adjuvant to local anaesthetics for spinal anaesthesia for caesarean delivery. This opens the debate as to whether intrathecal clonidine as an "off label" prescription should be reconsidered by medical regulatory authorities.
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Int J Obstet Anesth · May 2017
Review Meta AnalysisAnesthetic considerations for labor and delivery in women with cerebrospinal fluid shunts.
The anesthetic management of labor and delivery in pregnant women with cerebrospinal fluid shunts can be challenging. We conducted a literature review to understand the anesthetic implications in pregnant women with cerebrospinal fluid shunts. ⋯ This review suggests that shunt malfunctions occurred commonly during pregnancy. The presence of neurological symptoms warrants careful evaluation of shunt function. Anesthetic management for labor and delivery varied and was dependent on shunt function. Epidural analgesia appears to be safe in women with functional shunts.
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Int J Obstet Anesth · May 2017
Review Meta AnalysisCranial nerve palsy following central neuraxial block in obstetrics - a review of the literature and analysis of 43 case reports.
Cranial nerve palsy is a rarely reported complication of central neuraxial block in obstetrics. The aetiology is diverse and includes both decreased and increased intracranial pressure. ⋯ Intracranial hypotension is the most common aetiology of cranial nerve palsy after central neuraxial block in obstetrics. Neuroimaging is recommended in every case, to exclude other neurological causes. Epidural blood patch was the most utilised treatment for post-dural puncture cranial nerve palsy, but outcomes were variable. The majority of cranial nerve palsies resolved over the subsequent weeks and months.
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Int J Obstet Anesth · Dec 2016
Meta AnalysisClinical effectiveness of transversus abdominis plane (TAP) blocks for pain relief after caesarean section: a meta-analysis.
The effectiveness of transversus abdominis plane (TAP) blocks for acute pain relief after caesarean section, in comparison to normal practice, remains uncertain. ⋯ TAP blocks provide effective analgesia after caesarean section; however, additional benefits are more difficult to demonstrate when long-acting intrathecal opioids are administered.