Knowledge
Collections of articles, notes and knowledge from the metajournal community.
Airway
Analgesia
Anesthesia
Complications
Covid
Critical care
Decision making
Drugs
Epidural
Intrathecal
Intravenous anesthetics
Neuromuscular agents
Obstetric anesthesia
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Perioperative medicine
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Sugammadex
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There is some evidence supporting the benefit of perioperative intravenous lignocaine/lidocaine infusion in both laparoscopic and open abdominal surgery.
The strongest evidence supports both improved analgesia and reduction in nausea, with weaker evidence suggesting faster improvement in GIT function and earlier discharge from hospital.
Safety data is reassuring but far from conclusive due to the small size of most studies.
summary
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Cardiac arrest is rare in pregnancy (1 in 30,000) and resuscitation is founded on the same approach used for the non-pregnant patient, focusing on:
- Recognition
- Calling for help
- A B C (D)
- Good for mother = good for baby
However, unique to maternal resuscitation:
- Airway difficulties are more likely.
- Aortocaval compression dramatically impedes resuscitation – employ left lateral tilt!
- Consider perimortem cesarean section
The rationale for Perimortem Cesarean Section is:
- The presence of baby and gravid uterus severely limits resuscitation of the mother.
- Emergency cesarean section at cardiac arrest is done for the mother’s benefit, not the baby.
- A decision to perform emergency CS must be made within 4 minutes of arrest, and the baby delivered within 5 minutes. (Although there is some evidence of benefit when performed up to 10 minutes after arrest.)
- The only equipment required is a scalpel and an appropriately skilled doctor.
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