Cahiers d'anesthésiologie
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Anaesthesia for fetal distress is usually indicated for emergency caesarean section. General anaesthesia, which is the classical technique in these cases, remains the leading cause of anaesthesia-related maternal mortality. Difficult intubation and Mendelson's syndrome are mostly responsible for these fatalities. ⋯ For example, a "prophylactic" epidural instituted soon after the beginning of labor may be lifesaving in a patient with obvious signs of difficult intubation. A clear definition of safe standards of equipment and practices both to prevent Mendelson's syndrome or to cope with a failed intubation through a "failed intubation drill" is of paramount importance. Finally, a comprehensive communication between anesthetic and obstetrical teams is one of the most useful ways to allow a safer approach of the management of obstetric emergencies such as caesarean section for fetal distress.
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Cahiers d'anesthésiologie · Jan 1994
Review[Epidemiology of complications of obstetrical epidural analgesia].
Epidural analgesia (EA) is the best technique to obtain pain relief during labour. But the needle, the catheter and the local anaesthetics (LA) are 3 reasons to cause maternal complications. In France we do not know the exact number of EA performed every year and it is very difficult to appreciate the incidence of maternal complications. ⋯ The overall incidence of serious complications was 1/4,005 EA. The most frequent are accidental dural puncture (1/156), massive subarachnoid injections (1/8,010) and convulsions (1/9,011). The incidence of these 3 complications must be reduced by better training, material or attention during bolus injection of LA.
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Cahiers d'anesthésiologie · Jan 1994
Review[Emergency cesarean section: role of locoregional anesthesia].
Emergency cesarean section is sometimes required for acute fetal distress but also for some maternal vital emergencies. In spite of its maternal (Mendelson's syndrome, difficult intubation) and fetal (neonatal depression) risks, general anaesthesia was classically used. The arguments in favor of regional anaesthesia techniques for emergency cesarean section and the respective advantages of spinal and epidural anaesthesia are developed in this text. ⋯ In case of patchy or unilateral analgesia, it is particularly important to resite the catheter to avoid the need for emergency general anaesthesia to solve an inadequate epidural anaesthesia for cesarean section. Spinal anaesthesia is the technique of choice for its rapidity of action but its hemodynamic risks need a prior careful evaluation of maternal hemodynamics. General anaesthesia will be always indispensable in some cases; therefore, every anaesthetist should maintain sufficient experience and skills in the management of some of its complications, especially intubation difficulties.
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The use of regional anaesthesia in day care practice is discussed. Five criteria of discharge are described: the four "A"s: awake, ambulation, alimentation, analgesia plus micturition. Complementary sedation with the regional block, if needed, should be midazolam and fentanyl. ⋯ However, urinary retention and orthostatic hypotension can occur. Furthermore the risk of headache is not a contraindication to an ambulatory practice if some guidelines are observed. In addition, penile blocks and caudal blocks are widely used in pediatrics.
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Cahiers d'anesthésiologie · Jan 1993
Review[Vascular filling and vasopressors: effects on the fetus and the newborn infant].
Epidural analgesia and anaesthesia are more and more commonly used in modern obstetrical anaesthesia practice leading to the frequent use of fluid infusion and vasopressors. Fetal and neonatal effects of these treatments are reviewed here and may be summarized as follows: 1) Prolonged and/or severe maternal arterial hypotension may induce fetal hypoxia and acidosis, especially when fetal status is already compromised (uteroplacental insufficiency). 2) Preventive fluid hydratation with crystalloids associated with left uterine displacement are always useful to avoid maternal hypotension. 3) Dextrose-containing solutions are undesirable for the prevention of treatment of maternal hypotension as they may induce delayed neonatal hypoglycemia. 4) When the parturient is correctly hydrated, the rapid use of intravenous ephedrine is efficient in restoring normal maternal arterial pressure and has no deleterious effect on the fetus and the newborn. Finally, rapid, repetitive and non-invasive monitoring of maternal arterial pressure is the prerequisite to a rapid management of maternal hypotension which is essential to avoid any deleterious effect to the fetus and the neonate.