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Ragbourne SC, Charles E, Herincs M, Desai N. Anaesthetic considerations for impacted fetal head at caesarean delivery: a focused review. Int J Obstet Anesth 2024; 61:104268. [PMID: 39342879 DOI: 10.1016/j.ijoa.2024.104268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 09/10/2024] [Accepted: 09/12/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Impacted fetal head occurs when the fetal head is deeply engaged within the maternal pelvis and difficult to deliver during caesarean delivery. In order to deliver the fetal head, additional surgical manoeuvres and/or pharmacological tocolysis are needed. The aim of this focused review is to outline the incidence, risk factors, management and complications of this obstetric emergency from the perspective of the anaesthetist. METHODS Databases were searched for free text headings and subject headings associated with different permutations of terms related to impacted fetal head and caesarean delivery. RESULTS Impacted fetal head has been estimated to occur in 1.5 % of elective caesarean deliveries and 2.9-18.4% of all emergency caesarean deliveries at any cervical dilatation. Risk factors include advanced cervical dilatation, labour augmentation with oxytocin, prolonged second stage of labour, fetal malposition and junior grade of operating obstetrician. If impacted fetal head occurs, the anaesthetist in conjunction with the multidisciplinary team should consider decreasing the height of the operating table, providing a step for the obstetrician to stand on, placing the patient in the head down position, providing pharmacological tocolysis with glyceryl trinitrate (or nitroglycerin), beta-2 adrenoreceptor agonists or volatile anaesthetic agents, and managing complications such as postpartum haemorrhage. CONCLUSION Impacted fetal head is an obstetric emergency that the anaesthetist should be familiar with and has a vital role in managing. We propose an algorithm for management that may serve as a clinical decision aid.
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Affiliation(s)
- S C Ragbourne
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - E Charles
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - M Herincs
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - N Desai
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Honorary Senior Clinical Lecturer, King's College London, London, United Kingdom.
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Ragbourne SC, Charles E, Herincs M, Elwen F, Desai N. Impacted fetal head at cesarean delivery. J Clin Anesth 2024; 99:111598. [PMID: 39276524 DOI: 10.1016/j.jclinane.2024.111598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 08/08/2024] [Accepted: 09/02/2024] [Indexed: 09/17/2024]
Abstract
PURPOSE Impacted fetal head (IFH) can be defined as the deep engagement of the fetal head in the maternal pelvis at the time of cesarean delivery that leads to its difficult or impossible extraction with standard surgical maneuvers. In this narrative review, we aimed to ascertain its incidence, risk factors, management and complications from the perspective of the anesthesiologist as a multidisciplinary team member. METHODS Databases were searched from inception to 24 January 2023 for keywords and subject headings associated with IFH and cesarean delivery. RESULTS IFH has an incidence of 2.9-71.8 % in emergency cesarean section. Maternal risk factors are advanced cervical dilatation, second stage of labor and oxytocin augmentation. Anesthetic and obstetric risk factors include epidural analgesia and trial of instrumental delivery and junior obstetrician, respectively. Neonatal risk factors are fetal malposition, caput and molding. Current evidence indicates a lack of confidence in the management of IFH across the multidisciplinary team. Simple interventions in IFH include lowering the height or placing the operating table in the Trendelenburg position, providing a step for the obstetrician and administering pharmacological tocolysis. Maternal complications are postpartum hemorrhage and bladder injury while neonatal complications include hypoxic brain injury, skull fracture and death. Surgical complications are reviewed to remind the anesthesiologist to anticipate and prepare for potential problems and manage complications in a timely manner. CONCLUSION The anesthesiologist has a fundamental role in the facilitation of delivery in IFH. We have proposed an evidence based management algorithm which may be referred to in this emergency situation.
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Affiliation(s)
- Sophie C Ragbourne
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Elinor Charles
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Maria Herincs
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Francesca Elwen
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Neel Desai
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Honorary Senior Clinical Lecturer, King's College London, London, United Kingdom.
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Sharpe EE, Rose CH, Tweet MS. Obstetric anesthesia considerations in pregnancy-associated myocardial infarction: a focused review. Int J Obstet Anesth 2024:104233. [PMID: 39227292 DOI: 10.1016/j.ijoa.2024.104233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 07/12/2024] [Accepted: 07/14/2024] [Indexed: 09/05/2024]
Abstract
Pregnancy-associated myocardial infarction (PAMI) is a rare but serious complication that can occur either during pregnancy or postpartum. The etiologies of PAMI are atherosclerosis, spontaneous coronary artery dissection, coronary thrombosis, coronary embolism, and coronary vasospasm. Therapy of acute PAMI depends largely on the ECG presentation, hemodynamic stability, and suspected etiology of myocardial infarction. Anesthetic management during delivery in patients with PAMI should consist of early and carefully titrated neuraxial analgesia and anesthesia, maintenance of normal sinus rhythm, preservation of afterload, and monitoring for and avoiding myocardial ischemia. To improve the care of women with PAMI, a multidisciplinary team of cardiologists, maternal fetal medicine specialists, obstetric providers, neonatologists, and anesthesiologists must work collectively to manage these complex patients.
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Affiliation(s)
- E E Sharpe
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st Street S.W., Rochester, MN, United States.
| | - C H Rose
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mayo Clinic, 200 1st Street S.W., Rochester, MN, United States
| | - M S Tweet
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st Street S.W., Rochester, MN, United States
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Jayasooriya GS, Carvalho JCA, Luca A, Balki M. The Effects of Nitroglycerin on the Oxytocin Dose-Response Profile in Oxytocin-Desensitized and Naïve Human Myometrium: An In Vitro Study. Anesth Analg 2021; 132:231-239. [PMID: 32858531 DOI: 10.1213/ane.0000000000005055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Nitroglycerin is used for acute reduction in uterine tone. Prolonged oxytocin exposure causes desensitization of oxytocin receptors. It is unknown if nitroglycerin exposure impacts the subsequent action of oxytocin in the setting of oxytocin receptor desensitization. This study investigated the effects of nitroglycerin on oxytocin-desensitized and oxytocin-naïve human myometrium and the subsequent response to oxytocin dose-response testing in vitro. METHODS Myometrial samples from 17 elective cesarean deliveries were divided into strips and allocated to 1 of 4 groups: (1) oxytocin desensitized and no nitroglycerin; (2) oxytocin desensitized and nitroglycerin; (3) oxytocin naïve and nitroglycerin; and (4) oxytocin naïve and no nitroglycerin. Final analysis included 28 strips per group. Nitroglycerin groups were exposed to incremental concentrations of nitroglycerin, while no nitroglycerin groups were kept in control (physiological salt) solution. All groups then underwent oxytocin dose-response testing. Primary outcome was motility index (amplitude × frequency; grams × contractions per 10 minutes [g·c/10 min]). Secondary outcomes were amplitude (g), frequency (contractions/10 minutes), and area under the curve (g·s). All outcomes (nitroglycerin and oxytocin dose-response periods) were expressed as a percentage change from baseline. Values were log transformed, compared using regression modeling and reported as the ratio of 2 geometric means (relative difference). RESULTS No significant difference was observed in motility index following nitroglycerin administration in oxytocin-desensitized versus oxytocin-naïve groups (relative difference = 19.0%; 95% confidence interval [CI], -32.6 to 109.9; P = .55). On oxytocin dose-response testing, motility index was highest in oxytocin-naïve and no nitroglycerin samples (group 4) (1.356 g·c/10 minutes) followed by oxytocin-naïve and nitroglycerin (group 3) (0.882 g·c/10 minutes), oxytocin-desensitized and no nitroglycerin (group 1) (0.769 g·c/10 minutes), and oxytocin-desensitized and nitroglycerin (group 2) (0.651 g·c/10 minutes) samples. Motility index was significantly reduced in group 1 vs 4 (relative difference = -43.3%; 95% CI, -66.5 to -4.1; P = .034) and group 2 vs 4 (relative difference = -52.0%; 95% CI, -70.9 to -20.8; P = .004). While in groups 3 vs 4, both amplitude (relative difference = -17.8%; 95% CI, -30.9 to -2.2; P = .27) and area under the curve (AUC; relative difference = -17.5%; 95% CI, -30.7 to -1.8; P = .030) were reduced. CONCLUSIONS Nitroglycerin-induced relaxation was not different between oxytocin-desensitized and oxytocin-naïve human myometrial strips in vitro. However, oxytocin-induced contractility was attenuated after nitroglycerin exposure in both oxytocin-desensitized and oxytocin-naïve samples, with maximum attenuation observed in desensitized tissues. This finding warrants further clinical studies to explore uterine responsiveness to oxytocin in women with oxytocin-augmented labors after nitroglycerin administration.
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Affiliation(s)
- Gayani S Jayasooriya
- From the Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Abbas AM, Ragab E, Abd Ellah NH, Sabra A, Ali SS, Mohamed A, Yosef AH. Effect of topical glyceryl trinitrate cream on pain perception during intrauterine device insertion in multiparous women: A randomized double-blinded placebo-controlled study. J Gynecol Obstet Hum Reprod 2019; 48:715-718. [PMID: 30898632 DOI: 10.1016/j.jogoh.2019.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/25/2019] [Accepted: 03/15/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Intrauterine contraceptive device (IUD) insertion-related pain presents a push beyond the decline of women to use IUD for family planning. We aimed to investigate the analgesic effect of glyceryl trinitrate cream (GTN) in reducing pain during IUD insertion. MATERIALS AND METHODS We conducted a randomized double-blinded placebo-controlled study (NCT02708251, clinicaltrials.gov) in a tertiary University hospital. Reproductive-aged women requesting Copper IUD for contraception were considered. Eligible women for IUD insertion were randomized (1:1) to glyceryl trinitrate cream (GTN arm) or Placebo. Three minutes before IUD insertion, 1 ml of GTN cream or placebo was applied to the cervical lip at the planned tenaculum site, followed by 1 ml placed in the cervical canal up to the level of the internal os using a Q-tip applicator. Our outcomes were the participant's self-rated pain perception utilizing a 10-cm Visual Analogue Scale (VAS) during cervical tenaculum placement, uterine sound and IUD insertion, then 15 min post-procedure. RESULTS 100 women were enrolled and randomized to GTN arm (n = 50) or placebo (n = 50). Women in the GTN arm reported lower VAS scores during tenaculum placement, sound and IUD insertion (median: 2 vs. 4, p < 0.0001; 2.5 vs. 4.5, p < 0.001;3 vs. 5.5, p < 0.0001, respectively). Higher ease of insertion score was also determined among GTN arm (mean ± SD: 6.9 ± 1.15 vs. 4.7 ± 1.38, p < 0.0001). Additionally, women in the GTN arm were more satisfied by the end of the insertion (92% vs. 74%, p = 0.003). CONCLUSION Application of cervical GTN cream before IUD insertion seems to reduce the induced pain with subsequent easy insertion.
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Affiliation(s)
- Ahmed M Abbas
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University, Egypt.
| | - Ebtehal Ragab
- Department of Obstetrics and Gynaecology, Assiut General Hospital, Egypt
| | - Noura H Abd Ellah
- Department of Pharmaceuticals, Faculty of Pharmacy, Assiut University, Egypt
| | - Ali Sabra
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University, Egypt
| | - Shymaa S Ali
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Suez University, Egypt
| | - Ahmed Mohamed
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University, Egypt
| | - Ali H Yosef
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University, Egypt
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The effect of nitroglycerin on the IUD insertion experience in nulliparous women: a pilot study. Contraception 2014; 90:60-5. [DOI: 10.1016/j.contraception.2014.03.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/15/2014] [Accepted: 03/20/2014] [Indexed: 11/24/2022]
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7
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Bednarek PH, Micks EA, Edelman AB, Li H, Jensen JT. The effect of nitroprusside on IUD insertion experience in nulliparous women: a pilot study. Contraception 2013; 87:421-5. [DOI: 10.1016/j.contraception.2012.10.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 10/25/2012] [Accepted: 10/26/2012] [Indexed: 11/17/2022]
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Dhawan R, Kacha A, Chaney MA, Fox AA, Wong CA. Case 2--2011: Acute myocardial infarction in a pregnant patient requiring coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2011; 25:353-61. [PMID: 21295495 DOI: 10.1053/j.jvca.2010.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Indexed: 11/11/2022]
Affiliation(s)
- Richa Dhawan
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL, USA
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Visalyaputra S, Prechapanich J, Suwanvichai S, Yimyam S, Permpolprasert L, Suksopee P. Intravenous nitroglycerin for controlled cord traction in the management of retained placenta. Int J Gynaecol Obstet 2010; 112:103-6. [PMID: 21144515 DOI: 10.1016/j.ijgo.2010.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 08/16/2010] [Accepted: 10/29/2010] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine the effect of 200 μg of intravenous nitroglycerin in the release of retained placenta by controlled cord traction. METHODS In this randomized controlled study, 40 women with a placenta retained for 30 minutes received intravenously 200 μg of nitroglycerin or a normal saline solution before umbilical cord traction was initiated. The rates of successful removal of the retained placenta in the study (n=20) and control (n=20) groups were compared, as were blood pressure, pulse rate, blood loss, and adverse effects. RESULTS The placenta was released in only 15% and 20% of the participants in the study and control group, respectively. The remainder of the participants required general anesthesia and manual removal of the retained placenta regardless of group assignation. Blood pressure fell in significantly more women in the study group, but there were no differences in estimated blood loss or minor adverse effects. CONCLUSION Intravenously administered nitroglycerin did not facilitate the release of retained placenta by umbilical cord traction. However, cord traction may be performed longer than 30 minutes to attempt releasing the placenta before operative manual removal is initiated.
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Benonis JG, Habib AS. Ex utero intrapartum treatment procedure in a patient with arthrogryposis multiplex congenita, using continuous spinal anesthesia and intravenous nitroglycerin for uterine relaxation. Int J Obstet Anesth 2008; 17:53-6. [PMID: 17451933 DOI: 10.1016/j.ijoa.2007.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 01/03/2007] [Indexed: 11/19/2022]
Abstract
The ex utero intrapartum treatment procedure allows for the controlled management of a potentially life-threatening difficult airway in the newborn. General anesthesia has previously been reported for the management of this procedure. We report the use of continuous spinal anesthesia in conjunction with intravenous nitroglycerin for the ex utero intrapartum treatment procedure in a woman with arthrogryposis multiplex congenita, a rare syndrome characterized by rigid joints and limb contractures.
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Affiliation(s)
- J G Benonis
- Division of Women's Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
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Pullen KM, Riley ET, Waller SA, Taylor L, Caughey AB, Druzin ML, El-Sayed YY. Randomized comparison of intravenous terbutaline vs nitroglycerin for acute intrapartum fetal resuscitation. Am J Obstet Gynecol 2007; 197:414.e1-6. [PMID: 17904983 DOI: 10.1016/j.ajog.2007.06.063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 05/05/2007] [Accepted: 06/28/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to compare terbutaline and nitroglycerin for acute intrapartum fetal resuscitation. STUDY DESIGN Women between 32-, 42 weeks' gestation were assigned randomly to 250 microg of terbutaline or 400 microg nitroglycerin intravenously for nonreassuring fetal heart rate tracings in labor. The rate of successful acute intrapartum fetal resuscitation and the maternal hemodynamic changes were compared. Assuming a 50% failure rate in the terbutaline arm, we calculated that a total of 110 patients would be required to detect a 50% reduction in failure in the nitroglycerin group (50% to 25%), with an alpha value of .05, a beta value of .20, and a power of 80%. RESULTS One hundred ten women had nonreassuring fetal heart rate tracings in labor; 57 women received terbutaline, and 53 women received nitroglycerin. Successful acute resuscitation rates were similar (terbutaline 71.9% and nitroglycerin 64.2%; P = .38). Terbutaline resulted in lower median contraction frequency per 10 minutes (2.9 [25-75 percentile, 1.7- 3.3] vs 4 [25-75 percentile, 2.5- 5]; P < .002) and reduced tachysystole (1.8% vs 18.9%; P = .003). Maternal mean arterial pressures decreased with nitroglycerin (81-76 mm Hg; P = .02), but not terbutaline (82-81 mm Hg; P = .73). CONCLUSION Although terbutaline provided more effective tocolysis with less impact on maternal blood pressure, no difference was noted between nitroglycerin and terbutaline in successful acute intrapartum fetal resuscitation.
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Affiliation(s)
- Kristin M Pullen
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
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Clark KD, Viscomi CM, Lowell J, Chien EK. Nitroglycerin for Relaxation to Establish a Fetal Airway (EXIT Procedure). Obstet Gynecol 2004; 103:1113-5. [PMID: 15121627 DOI: 10.1097/01.aog.0000125158.61232.b3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ex utero intrapartum treatment (EXIT) procedure is a technique designed to establish an airway at the time of delivery in fetuses at risk of airway obstruction and requires maintenance of uterine relaxation to continue placental perfusion and prevent placental separation. We describe the use of intravenous nitroglycerin to maintain uterine relaxation during the EXIT procedure. CASE A 17-year-old primigravida with a fetus known to have an anterior neck mass was admitted for a scheduled operative delivery at 38 weeks of gestation using a modified EXIT procedure. Anesthesia was administered with a combined spinal-epidural technique. Intravenous nitroglycerin was administered as a bolus and then as a continuous infusion to maintain uterine relaxation until evaluation of the neonatal airway was completed. CONCLUSION Intravenous nitroglycerin is an effective agent for maintenance of uterine relaxation and placental perfusion during the EXIT procedure.
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Affiliation(s)
- Kelley D Clark
- Department of Obstetrics and Gynecology, Fletcher Allen Health Care, University of Vermont, Burlington, Vermont 05401, USA.
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Grant MKO, El-Fakahany EE. Therapeutic interventions targeting the nitric oxide system: current and potential uses in obstetrics, bone disease and erectile dysfunction. Life Sci 2004; 74:1701-21. [PMID: 14741730 DOI: 10.1016/j.lfs.2003.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Nitric oxide is involved in a countless number of physiological processes and is known to have cytoprotective as well as cytotoxic effects. Increased knowledge about the multifaceted role of nitric oxide in a variety of disease states has led to the design of multiple treatment strategies involving the nitric oxide system. The current review focuses on recent research advances in the fields of obstetrics, bone disease and erectile dysfunction that have led to current or potential future therapies involving nitric oxide.
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Affiliation(s)
- Marianne K O Grant
- Neuroscience Research in Psychiatry, University of Minnesota Medical School, Mayo Mail Code 392, 420 Delaware Street S.E., Minneapolis, MN 55455, USA
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Abstract
Obstetric hemorrhage is still a significant cause of maternal morbidity and mortality. Prevention, early recognition, and prompt intervention are the keys to minimizing complications. Resuscitation can be inadequate because of under-estimation of blood loss and misleading maternal response. A young woman may maintain a normal blood pressure until sudden and catastrophic decompensation occurs. All members of the obstetric team should know how to manage hemorrhage because timing is of the essence. Good communication with the blood bank ensures timely release of appropriate blood products. A well-coordinated team is one of the most important elements in the care of a compromised fetus. If fetal anoxia is presumed, there is less than 10 minutes to permanent fetal brain damage. Antepartum anesthesia consultation should be encouraged in parturients with medical problems.
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Affiliation(s)
- Chantal Crochetière
- Department of Anesthesiology, Sainte-Justine Hospital, University of Montreal, 3175 Côte-Ste-Catherine, Montreal, Quebec, Canada H3T 1C5.
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Collins DW, Downs CS, Katz SG, Gatt SP, Marsland C, Abrahams N, Turner RJ. Airway management on placental support (AMPS)--the anaesthetic perspective. Anaesth Intensive Care 2002; 30:647-59. [PMID: 12413268 DOI: 10.1177/0310057x0203000518] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neonatal airway obstruction has been reported to have a high mortality. Antenatal diagnosis of this condition is now possible. Anaesthetic and surgical techniques have been developed that allow neonatal airway obstruction to be managed at delivery, while the fetus remains oxygenated via the placental circulation. Three case studies are presented, and the anaesthetic issues for mother and fetus/neonate are discussed with reference to previously published cases of airway management on placental support. In particular, techniques for uterine relaxation and maintenance of placental circulation are explored. The history of these procedures and issues of planning and logistics are also discussed.
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Affiliation(s)
- D W Collins
- Department of Anaesthesia, Sydney Children's Hospital Randwick, NSW, Australia
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Cherayil G, Feinberg B, Robinson J, Tsen LC. Central neuraxial blockade promotes external cephalic version success after a failed attempt. Anesth Analg 2002; 94:1589-92, table of contents. [PMID: 12032033 DOI: 10.1097/00000539-200206000-00041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED External cephalic version (ECV) has been successfully used to decrease the fetal and maternal morbidity and costs of cesarean delivery. As there are limited data regarding the use of central neuraxial blockade in the setting of previously failed ECV attempts, we sought to evaluate the efficacy and safety of spinal and epidural anesthesia in this setting. A retrospective review of all ECV attempts performed by a single experienced obstetrician between 1995 and 1999 was conducted. Standardized tocolytic and anesthetic regimens were used. A total of 77 patients underwent ECV attempts; of these, 37 (48%) were unsuccessful, 15 of which consented to further attempts with anesthesia. Neuraxial anesthesia was associated with frequent ECV success in both multiparous 4/4 (100%) and nulliparous 9/11 (82%) parturients. Overall 5/6 (83%) and 8/9 (89%) (P = NS) ECV attempts were successful with spinal and epidural anesthesia, respectively, with 2/5 (40%) and 6/8 (75%) (P = NS) resulting in vaginal deliveries. One successful ECV in the epidural group had an urgent cesarean delivery for persistent fetal bradycardia with good neonatal and maternal outcomes. We conclude central neuraxial anesthesia promotes successful ECV after previously failed ECV attempts. IMPLICATIONS Our retrospective analysis of central neuraxial techniques, both epidural and spinal anesthesia, noted a significant success rate in the setting of previously failed external cephalic version attempts.
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Affiliation(s)
- Gerald Cherayil
- Department of Anesthesiology, Harvard Medical School, Brigham and Women's Hospital, CWN-L1, Boston, MA 02115, USA
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Cherayil G, Feinberg B, Robinson J, Tsen LC. Central Neuraxial Blockade Promotes External Cephalic Version Success After a Failed Attempt. Anesth Analg 2002. [DOI: 10.1213/00000539-200206000-00041] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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