Obstetric anesthesia management of dilated cardiomyopathies and heart failure: a narrative review.

Pregnancy in patients with dilated cardiomyopathy carries a significantly increased risk of maternal mortality or severe morbidity, and pregnancy is typically considered contraindicated for patients with severely reduced ventricular function. Nonetheless, anesthesiologists will still encounter patients with cardiomyopathy requiring delivery or termination care. This review describes how NT-ProBNP testing and echocardiography can help with early recognition of heart failure in pregnancy, and describes a suggested approach to anesthetic management of patients with cardiomyopathies or acute heart failure, including hemodynamic goals, use of vasoactive medications and mechanical support. Vaginal delivery, with effective neuraxial anesthesia is the preferred mode of delivery in most patients with cardiomyopathy, with cesarean delivery reserved for maternal or fetal indications. The Pregnancy Heart Team is vital in coordinating the multidisciplinary care necessary to safely support these patients through pregnancy.

How low did we go? A case report of unexpected thrombocytopenia.

We report the case of a normotensive 31-year-old parturient who received combined spinal-epidural analgesia for early labor, and who was then found to have an unexpectedly low platelet count (25 000/µL) with elevated liver enzymes, but without alterations in blood pressure.

A study of factors influencing surgical cesarean delivery times in an academic tertiary center.

BACKGROUND: Knowledge of hospital-specific average cesarean delivery operative times, and factors influencing length of surgery, can serve as a guide for anesthesiologists when choosing the optimal anesthetic technique. The aim of this study was to determine operative times and the factors influencing those times for cesarean delivery. METHODS: We conducted a retrospective review of all 1348 cesarean deliveries performed at an academic hospital in 2011. The primary outcome was mean operative time for first, second, third and fourth or more cesarean deliveries. The secondary goal was to identify factors influencing operative time. Variables included age, body mass index, previous surgery, gestational age, urgency of cesarean delivery, anesthesia type, surgeon's seniority, layers closed, and performance of tubal ligation. RESULTS: Mean (standard deviation) operative times for first (n=857), second (n=353), third (n=108) and fourth or more (n=30) cesarean deliveries were 56 (19), 60 (19), 69 (28) and 82 (31) minutes, respectively (P <0.0001, all groups different). Emergency status of the case and later gestational age were associated with shorter operative times. Higher body mass index, a less senior surgeon, the number of layers closed, and tubal ligation, increased operative times. These factors accounted for 18% of the variability. CONCLUSIONS: Third and fourth cesarean delivery or the presence of other factors that could increase operative time may warrant catheter-based anesthetic techniques or the addition of adjunctive medications to prolong spinal anesthetic block. Institutional and individual surgeon factors may play an even more important role in determining surgical time.

[The long-term effect analysis of the tongue base traction/ hyoid suspension with Repose system in multiplanar surgery].

Objective:To explore the long-term effect of Repose bone screw system in the treatment of severe obstructive sleep apnea syndrome in patients with severe obstructive sleep apnea. Method:The follow-up group was divided into the short-term (<12 months, control group, 30 cases) and the long-term (more than 12 months, observation, 46 cases). And compared the operation effect of the two groups. Furthermore, the parameters and related factors of surgical efficacy of patients with different follow-up time and different surgical methods were further analyzed.Result:①There was no statistical difference in the preoperative parameters of the two groups, and the overall efficiency of the postoperative long-term observation group was 78.3%, compared with 90.0% in the short-term control group, and the inefficiencies increased from 10.0% to 21.7%. ②In the observation group, the mean of the AHI increased gradually with the follow-up time, and the blood oxygen gradually decreased. The effectiveness of the surgical treatment gradually decreased, the total efficiency of the tongue base traction group decreased from 100% to 60%, and the hyoid suspension group decreased from 94.4% to 77.8%. ③And 15 patients with a second review X-head shadow measurements,we found there are statistically significant (P<0.05) in vallecula epiglottica-lateral pharyngealwall,pharyngeal airway space. Conclusion:Repose screw system of tongue base traction/ hyoid suspension technique is positive in the treatment of severe OSAHS lingual pharyngeal plane obstruction, but short-term surgical results are not stable.

Diagnosis of primary adenocarcinoma of the fallopian tube.

Primary carcinoma of the fallopian tube is rare, but still occurs frequently enough to warrant consideration when certain specific symptoms are present. It is also possible to diagnose the tumor correctly if, in the presence of certain symptoms, the following diagnostic tools are used in addition to repeated Pap smears and dilatation and curettage: hysteroscopy, cervical biopsy, colposcopy, laparoscopy, laparotomy, and pathological examination of every tubal specimen.