Best practice & research. Clinical obstetrics & gynaecology
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Best Pract Res Clin Obstet Gynaecol · Jun 2010
ReviewPharmacogenetic influences in obstetric anaesthesia.
Genomic discoveries in the field of perioperative medicine and anaesthesia have generated multiple publications and some hope that pharmacogenetic testing may guide clinicians to provide safe and effective medicine in a 'tailored' manner. Within the field of anaesthesia, many consider that 'titration of drugs to the desired effect works just fine' and wonder if pharmacogenomics will ever impact on their daily practice. This review will cite practical examples of relevant candidates genes and common polymorphisms that have shown to alter the response to medication prescribed in the peripartum period by obstetricians and anaesthesiologists.
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Best Pract Res Clin Obstet Gynaecol · Jun 2010
ReviewCardiopulmonary resuscitation and the parturient.
Cardiopulmonary arrest occurs in 1: 30 000 pregnancies. Although rare, optimal outcomes are dependent on the cause of the arrest, the rapid response team's understanding of the physiological effects of pregnancy on the resuscitative efforts and application of the latest principles of advanced cardiac life support (ACLS). Anaesthesia-related complications, secondary to difficult or failed intubation, and inability to oxygenate and ventilate can result in adverse outcomes for mother and baby. ⋯ Delivery of the baby helps in the maternal resuscitation efforts and recovery of circulation. Finally, the 2003 International Liaison Committee on Resuscitation (ILCOR) and the 2005 American Heart Association (AHA) advocate the provision of mild therapeutic hypothermia to the survivors of cardiac arrest. This will improve the neurological outcomes by decreasing cerebral oxygen consumption, suppression of the radical reactions and reduction of intracellular acidosis and inhibition of excitatory neurotransmitters.
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Best Pract Res Clin Obstet Gynaecol · Jun 2010
ReviewThe ongoing challenges of regional and general anaesthesia in obstetrics.
The increasing trend of caesarean section in the setting of increasing maternal age, obesity and other concomitant diseases will continue to challenge the obstetric anaesthetist in his/her task of providing regional and general anaesthesia. The challenges of providing anaesthesia for an emergency caesarean section, particularly the risks of general anaesthesia, will be debated. The need for involvement of a multidisciplinary team, good communication and challenges surrounding the provision of anaesthesia to such patients are discussed.
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Every minute of every day, a woman dies in pregnancy or childbirth. The biggest killer is obstetric haemorrhage, the successful treatment of which is a challenge for both the developed and developing worlds. The presence of an attendant at every birth and access to emergency obstetric care are key to reducing maternal morbidity and mortality in the developing world while resource-rich countries have a rising caesarean section rate with its consequential effect on the incidence of abnormal placentation and its link with peripartum hysterectomy. ⋯ Various methods are available to try to stop the bleeding - from pharmacological methods to aid uterine contraction (e.g., oxytocinon, ergometrine and prostaglandins) to surgical methods to stem the bleeding (e.g., balloon tamponade, compression sutures or arterial ligation). Interventional radiology can be used if placenta accreta is suspected. Cell salvage has been introduced into obstetrics relatively recently in an attempt to reduce allogeneic transfusion.
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The coagulation system undergoes significant change during pregnancy. The clinician caring for the parturient must understand these changes, particularly when the parturient has a pre-existing haematological condition. Because many haematological conditions are rare, there often is limited information to guide the obstetric and anaesthetic management of these parturients.