Articles: outcome.
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The dramatic decline in mortality related to cardiac surgery has resulted in over 330,000 surgeries involving cardiopulmonary bypass (CPB) being performed yearly in the United States. Although few patients die as a result of cardiac surgery, over two thirds of the patients demonstrate evidence of acute neuropsychological dysfunction postoperatively. The potential mechanisms contributing to post-CPB neuropsychological deficits are many, but two major inter-related etiologic factors, hypo-perfusion and emboli, are suggested as the probable culprits. ⋯ Conversely, if hypoperfusion is the cause of the injury, then decreasing brain blood flow to minimize embolic delivery would increase the likelihood of perfusion injury. By monitoring the carotid arteries of patients undergoing coronary artery bypass graft surgery, we have determined the frequency and quantity of embolic signals that occur during CPB. Although we have not been able to determine the nature of the embolus, gaseous or solid, we have demonstrated a relationship between the overall embolic load and the probability of having NP dysfunction. (ECHOCARDIOGRAPHY, Volume 13, September 1996)
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Int J Obstet Anesth · Jan 1996
Anesthetic considerations for parturients with primary pulmonary hypertension: review of the literature and clinical presentation.
Primary pulmonary hypertension, though uncommon, is found relatively frequently in women of childbearing age and carries a high peripartum mortality. We present a patient with severe primary pulmonary hypertension who underwent two cesarean sections 3 and 6 years after the diagnosis of primary pulmonary hypertension was made. Epidural anesthesia was provided on both occasions and resulted in a good maternal and fetal outcome. We have reviewed the literature as it relates to the choice of anesthetic technique and maternal outcome in patients with primary pulmonary hypertension.
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Int J Obstet Anesth · Jul 1995
Transfer of the critically ill obstetric patient: experience of a specialist team and guidelines for the non-specialist.
Transfer of the critically ill obstetric patient between hospitals is increasingly common. The specialist transfer team based at the Western Infirmary Intensive Therapy Unit, Glasgow has transported 60 such patients in the years 1985-1994. Monitoring was by direct arterial pressure measurement in 56 patients and central venous pressure measurement in 45. ⋯ The majority of patients had pregnancy induced hypertension or had suffered a post partum haemorrhage. A clinical impression that these two groups had different treatment requirements and outcomes was not substantiated. We conclude that the transfer of even the sickest obstetric patient is feasible and safe and suggest guidelines to non-specialists for the management of these patients before and during interhospital transfer.
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Int J Obstet Anesth · Jul 1995
A case of amniotic fluid embolism in a twin pregnancy in the second trimester.
We present a case of amniotic fluid embolism which is unusual in its presentation in the second trimester of a twin pregnancy, and which, after prompt and aggressive management, produced an equally unusual excellent maternal outcome.
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Int J Obstet Anesth · Apr 1995
The elective use of oxytocin infusion during labour in nulliparous women using epidural analgesia: a randomised double-blind placebo-controlled trial.
The obstetric outcome following the elective use of oxytocin infusion was determined in a randomised, double-blind placebo-controlled trial. 93 nulliparous women in a London hospital, who had requested epidural analgesia in labour (