Induction agents for Caesarean section

Peltz, B.; Sinclair, D. M.

doi:10.1111/j.1365-2044.1973.tb00282.x

Cited by 40 publications

(3 citation statements)

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“…Limited clinical and experimental data have shown that intravenous anesthetics have a mild effect on liver blood flow and have no obvious influence on liver function postoperatively when the blood pressure is maintained in a stable range [28,29,30,31]. Ketamine, an N-methyl- D -aspartate receptor antagonist, has been shown to be a superior intravenous anesthetic for the induction of general anesthesia in patients undergoing cesarean delivery, producing a lower incidence of awareness, enhanced postoperative analgesia, no emergence delirium and no reduced Apgar scores in the neonate [32,33]. In particular, ketamine has little effect on hepatic blood flow when used in obstetric anesthesia, even for large doses [28].…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of Acute Fatty Liver of Pregnancy: Twenty-Eight Cases and Discussion of Anesthesia

Zhou

Zhang

2013

Gynecol Obstet Invest

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Aims: To summarize the clinical features, perioperative management and maternal and neonatal outcomes of patients with acute fatty liver of pregnancy (AFLP) and to discuss the management of anesthesia in these patients. Methods: This study was a retrospective review over a period of 5 years and 9 months; 28 cases from the Shanghai Public Health Clinical Center were included. Records were reviewed for symptoms, signs, laboratory findings, clinical courses, perioperative management and maternal and neonatal outcomes. Results: Of the AFLP cases analyzed in the present study, 75.0% occurred in primipara and 63.3% occurred with male fetuses. Prodromic symptoms included the sudden onset of fatigue, nausea, vomiting, anorexia and jaundice. Laboratory results indicated liver function abnormalities, coagulopathy, hypoglycemia, leukocytosis and negative urine bilirubin. There were 2 maternal deaths (7.1%) without fetal deaths. Cesarean sections were performed in 16 cases under neuraxial anesthesia and in 12 cases under general anesthesia with rapid-sequence induction. Conclusion: Early diagnosis, prompt delivery and intensive supportive treatment are critical for improving the prognosis of AFLP. Anesthesia selection should be individualized and general anesthesia with rapid-sequence induction may be the best choice for patients with severe coagulopathy.

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Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of Acute Fatty Liver of Pregnancy: Twenty-Eight Cases and Discussion of Anesthesia

Zhou

Zhang

2013

Gynecol Obstet Invest

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“…Aside from its use in surgical practice, ketamine is often abused as a psychoactive substance, including consumption by pregnant women [55]. Besides the fact that repeated ketamine use and/or abuse results in fetal growth restriction and several characteristics of neurological abnormality, a brief intervention with ketamine is able to induce labor [56].…”

Section: Discussionmentioning

confidence: 99%

Prenatal Alcohol Exposure, Anesthesia, and Fetal Loss in Baboon Model of Pregnancy

Tobiasz¹,

Sullivan²,

Bursac³

et al. 2018

jdar

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Approximately half of pregnant women engage in alcohol consumption some time during pregnancy. On the other hand, a small percentage of pregnant women undergo surgery and anesthesia at some time during pregnancy. In emergencies, anesthesia has to be administered to patients who are under alcohol intoxication. Anesthetic management during pregnancy while patients are intoxicated with alcohol is challenging. Here, we utilized a retrospective analysis of data available from 17 pregnant baboons that underwent anesthesia with alcohol exposure during mid-pregnancy. The analysis was designed to answer three questions: whether maternal vital signs remained stable under anesthesia combined with alcohol, whether maternal vital signs that were routinely monitored under anesthesia could serve as predictor(s) of fetal loss, and what the impact of the combined application of anesthesia and alcohol was on fetal loss. For the purpose of this retrospective analysis, we utilized vital sign (heart and respiratory rates, temperature, oxygen, carbon dioxide, systolic and diastolic blood pressure) and pregnancy outcome (miscarriage versus fetal survival through second trimester-equivalent of human pregnancy) records from 17 pregnant baboons that underwent gastric infusion of either control or alcohol-containing drink under isoflurane anesthesia during the second trimester-equivalent of human pregnancy. Half of the dams underwent a brief prior anesthetic episode for the purpose of gestational age confirmation. Thus, in our analysis, baboons were divided into four groups: "Control" without prior anesthesia, "Control" with prior anesthesia, "Alcohol" without prior anesthesia, and "Alcohol" with prior anesthesia. We did not detect any maternal vital sign in any of the groups that would be predictive of a fetal loss. However, prior anesthesia predisposed dams to the risk of lowering maternal systolic blood pressure and to a significant decrease in maternal oxygen level during the combined application of anesthesia and alcohol. Conceivably, our data showed the largest fetal loss in this group. The disruptive nature of anesthesia and alcohol on maternal vital parameters warns against the use of anesthesia in combination with alcohol during pregnancy. Keywords anesthesia during pregnancy; alcohol exposure in utero; fetal alcohol exposure; nonhuman primate; adverse pregnancy outcome Abbreviations BAC: blood alcohol concentration; dGA: days of gestational age.

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“…A RAND study stated that "personal reductions… were at least partially imposed on CSS functions prior to thorough analysis…in effect, caps were set that pushed the Army toward the CSS goals." 7 The study further states, " It is imperative that the ideas developed with regard to how to provide capabilities not embedded in a unit are implemented." 8 The second statement clearly communicates that a highrisk adventure like this entails a back up -the trouble is that the force structure cuts eliminate a lot of the previous structure that could have provided those alternatives.…”

Section: The Joint Task Force (Jtf) Commander Knew That Operations Wementioning

confidence: 99%

CSS Transformation: Does The Emperor Have Clothes?

Juergens¹

2002

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Induction agents for Caesarean section

Cited by 40 publications

References 0 publications

Retrospective Analysis of Acute Fatty Liver of Pregnancy: Twenty-Eight Cases and Discussion of Anesthesia

Retrospective Analysis of Acute Fatty Liver of Pregnancy: Twenty-Eight Cases and Discussion of Anesthesia

Prenatal Alcohol Exposure, Anesthesia, and Fetal Loss in Baboon Model of Pregnancy

CSS Transformation: Does The Emperor Have Clothes?

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