Background: Morbidly adherent placenta (MAP) may cause life-threatening postpartum hemorrhage (PPH) requiring massive transfusions. Furthermore, it could endanger the lives of both mother and baby. Despite various efforts, such as adjuvant endovascular embolization and hysterectomy, massive PPH due to MAP still occurs and is difficult to overcome. Case: Herein, we described the case of a 40-year-old woman with placenta previa totalis who experienced massive bleeding during a cesarean section. We used resuscitative endovascular balloon occlusion of the aorta (REBOA) and it improved the condition of the surgical field and the hemodynamic stability of the patient temporarily. The patient was successfully managed without further complications. Conclusions: REBOA can be used as a rescue procedure for uncontrolled bleeding situations in patients with MAPs. Anesthesiologists should consider and recommend REBOA as another resuscitative therapeutic option in the case of massive PPH.
The extent of epidural anaesthesia and pattern of spread of contrast medium, using different injection techniques, has not been well documented. Therefore, in this prospective, randomized, double-blind study, the extent of anaesthesia and pattern of spread of contrast medium following an epidural bolus injection, via either a Tuohy needle or an epidural catheter, were compared.The study had two parts. In the first, 59 of 79 patients scheduled for a lower extremity operation under epidural anaesthesia were randomly allocated to one of the two groups. Anaesthesia was achieved with an epidural injection of 10 to 15 ml (including a 3 ml test dose) of 0.75% ropivacaine and fentanyl 25 µg via either a Tuohy needle (Group N, n=31) or a catheter (Group C, n=28). The level of sensory anaesthesia was recorded. In the second part, the remaining 20 patients were randomized to initially receive 5 ml of contrast medium via either a Tuohy needle (Group NE, n=10) or a catheter (Group CE, n=10). The extent of spread was recorded radiologically.Unilateral or missed blocks and additional dose requirement were absent in Groups N and C. No differences were found in the extent of sensory anaesthesia or the spread of contrast medium. Twenty per cent of catheter tips lay outside the lateral margins of the vertebral bodies.We found that an epidural bolus injection, via either a Tuohy needle or a catheter, made no difference in regard to spread of local anaesthetic or contrast medium in the epidural space. FIGURE 2: The spread of local anaesthetic. Sensory block level estimated by loss of pinprick sensation in patients receiving epidural injection of 0.75% ropivacaine 10 to15 ml and fentanyl 25 µg via a Tuohy needle (Group N) or an epidural catheter (Group C). No significant difference between groups. Box plots represent 10th-25th percentile /median /75th-90th percentile.
Objectives: This study investigated the effects of mouthwashes containing cetylpyridinium chloride and zinc acetate on oral health. Methods: A total of 60 participants were included in the study. Fifty-three participants (27 and 26 participants in the experimental and control groups, respectively) were retained, excluding seven candidates who dropped out. The mouthwash used for the study was spat out after 10-15 ml of mouth-washing for 3 s in the oral cavity after breakfast, lunch, and dinner. Oral examination indices included the gingival (gingival index, PMA index), the patient hygiene performance (PHP index, Turesky plaque index), and the bad breath (BB checker, Oral chroma) indices. Five measurements were taken after 2, 4, 6, 8, and 12 weeks and compared. Results: Measurements of the gingival index showed a statistically significant difference between the experimental and the control groups after 4 weeks, and the PMA index from eight weeks (P<0.05). Measurements of the PHP and Turesky plaque indices showed a significant difference in the experimental and control groups after 4 weeks (P<0.05). Compared to the PHP index before the experiment, that of the experimental group showed a significant index decrease after 2 weeks (P<0.05). Results of measuring bad breath through a BB checker showed a statistically significant difference between the experimental and control groups after 4 weeks (P<0.05). Conclusions: Oral mouthwash products containing cetylpyridinium chloride and zinc acetate relieves gingivitis, removes bacterial plaque, and reduces bad breath.
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