Lessons learned from obstetric anesthesia

Chestnut, D.H.

doi:10.1016/j.ijoa.2008.01.003

Cited by 15 publications

(8 citation statements)

References 18 publications

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“…Opioids are considered as a gold standard for achieving good analgesic action. However, opioids are usually avoided during the general anesthesia for cesarean delivery until the delivery of newborn because of possible risk of placental transfer and neonatal respiratory depression that is well described side effect of the opioid class (Chestnut 2008, Bouattour et al 2007). The avoidance of opioids can on the other hand lead to insufficient level of analgesia (Amin et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Maternal and Neonatal Effects of Remifentanil in Women Undergoing Cesarean Section in Relation to ABCB1 and OPRM1 Polymorphisms

Bakhouche

Nosková²,

Světlík³

et al. 2015

Physiol Res

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The aim of our study was to evaluate possible effect of ABCB1, and OPRM1 polymorphisms on the efficacy and safety of remifentanil in women undergoing elective cesarean section under general anesthesia. Women received remifentanil (1 µg/kg i.v.) 30 s prior to the induction to standardized general anesthesia. The ABCB1 (rs2032582, rs1045642) and OPRM1 (rs1799971) polymorphisms were analyzed from maternal peripheral blood. The basal hemodynamic and demographic parameters in the study population (n=54) were similar in all the subgroups. The median ± SD increase of systolic blood pressure at 5 min from the baseline was practically completely abolished in homozygous carriers of ABCB1 variants in comparison with wild-type subjects -2.67±25.0 vs. 16.57±15.7 mm Hg, p<0.05 for rs2032582, and 2.00±23.9 vs. 22.13±16.8 mm Hg, p<0.05, for rs1045642, respectively. While no neonate belonging to ABCB1 wild-type homozygous or OPRM1 variant carrying mothers needed any resuscitative measure, 10.5 % of the neonates belonging to OPRM1 wild-type homozygous mothers received resuscitative support similarly as 11.1 %, and 12.5 % of neonates of mothers carrying variants of rs2032582, and rs1045642, respectively. Decreased stabilizing effects of remifentanil on maternal hemodynamics has been observed in ABCB1 wild type mothers, while the adaptation of the neonates was clinically worse in OPRM1 wild type, and ABCB1 variant allele carriers.

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Section: Introductionmentioning

confidence: 99%

Maternal and Neonatal Effects of Remifentanil in Women Undergoing Cesarean Section in Relation to ABCB1 and OPRM1 Polymorphisms

Bakhouche

Nosková²,

Světlík³

et al. 2015

Physiol Res

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“…Patients with morbidly adherent placentation—accreta, increta, and percreta—are at considerable risk of hemorrhage, disseminated intravascular coagulation, multiple blood product transfusions, acute respiratory distress syndrome, and damage to intra-abdominal organs during delivery and removal of the placenta. 1 Reviews of the literature estimate that up to 25% of patients experience blood loss exceeding 5 L; patients have a 40% chance of requiring more than 10 units packed red blood cells and an overall maternal mortality of 7%. 2 The overall incidence of these cases has increased from 1/30,000 deliveries in the 1960s to more recent reports suggesting an increase as high as 1/300 over the past decade.…”

mentioning

confidence: 99%

Pilot Study of Intra-Aortic Balloon Occlusion to Limit Morbidity in Patients with Adherent Placentation Undergoing Cesarean Hysterectomy

Blumenthal

Rao

Murphy

et al. 2018

AJP Rep

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Objective We study whether using an intra-aortic balloon (IAB) during cesarean hysterectomy decreases delivery morbidity in patients with suspected morbidly adherent placentation. Study Design This is a retrospective cohort study of deliveries complicated by suspected abnormal placentation between 2009 and 2016 comparing maternal and neonatal outcomes with an IAB placed prior to cesarean hysterectomy versus no IAB. The primary outcome included quantified blood loss (QBL). Results Thirty-five cases were reviewed, 16 with IAB and 19 without IAB. No difference was seen in median QBL between the two groups (1,351 vs. 1,397 mL; p = 0.90). There were no significant differences in overall surgical complications (19% IAB, 21% no IAB; p = 0.86), bladder complications (12 vs. 21%; p = 0.66), intensive care unit admissions (12 vs. 26%; p = 0.41), surgical duration (2.9 vs. 2.8 hour; p = 0.83), or blood transfusions (median 2 vs. 2; p = 0.27) between the two groups. There was one groin hematoma at the balloon site that was managed conservatively. There were no complications involving thrombosis or limb ischemia in the IAB group. Conclusion While we did not detect statistically significant differences, larger studies may be warranted given the potential for extreme morbidity in these cases. This study highlights the potential use of an IAB in the management of these cases.

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“…Ne postoje druge okolnosti u kojima se smatra prihvatljivim da osoba pod nadzorom lekara podnosi jak bol koji bi se sigurnom intervencijom mogao ublažiti. U odsustvu medicinske kontraindikacije, zahtev majke je dovoljna indikacija za obezboljavanje porođaja" [4,10].…”

Section: Analgezija U Porođaju: Da Ili Ne?unclassified

Epidural analgesia in labor: specific characteristics, dilemmas and controversies

Kutlešić

Kutlesic

2012

Med pregl

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Lessons learned from obstetric anesthesia

Cited by 15 publications

References 18 publications

Maternal and Neonatal Effects of Remifentanil in Women Undergoing Cesarean Section in Relation to ABCB1 and OPRM1 Polymorphisms

Maternal and Neonatal Effects of Remifentanil in Women Undergoing Cesarean Section in Relation to ABCB1 and OPRM1 Polymorphisms

Pilot Study of Intra-Aortic Balloon Occlusion to Limit Morbidity in Patients with Adherent Placentation Undergoing Cesarean Hysterectomy

Epidural analgesia in labor: specific characteristics, dilemmas and controversies

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