Evaluation of the Association of Anaesthetists of Great Britain and Ireland lipid infusion protocol in bupivacaine induced cardiac arrest in rabbits.

Infusion of lipid emulsion has been demonstrated to facilitate return of spontaneous circulation in animal models and human cases of local anaesthetic induced cardiac arrest. Guidelines for lipid application exist; however, experimental evidence of efficacy at recommended dosing is lacking. In 20 sedated, mechanically ventilated, and invasively monitored New Zealand White rabbits, asystole was induced via bolus bupivacaine injection. Animals were randomised to receive either 20% Intralipid administered according to Association of Anaesthetists of Great Britain and Ireland guidelines, or identical volumes of 0.9% saline solution, in addition to standard Advanced Cardiac Life Support resuscitative measures. Seven lipid treated rabbits developed return of spontaneous circulation vs four saline treated animals (p = 0.370). A trend toward sooner return of spontaneous circulation in the lipid treated group was observed (2.4 (0.53) vs 3.8 (1.7) min; p = 0.082). Five animals in the lipid treated group survived to protocol termination vs nil animals from the saline treated group (p = 0.033). The current Association of Anaesthetists of Great Britain and Ireland lipid infusion protocol provides a useful beginning for lipid emulsion administration.

Intrapartum fetal monitoring: past, present, and future.

The concept of intrapartum "monitoring" of the fetal heart rate by auscultation has been extant for almost 200 years and by electronic means for more than 30 years. This article explores historical aspects of fetal monitoring, the advent of electronic fetal monitoring and its controversies, and present and future research opportunities to enhance the reliability, validity, and efficacy of fetal monitoring.

Promoting parenting: the obstetric patient in an intensive care unit.

The complex process of mastering the new parent role can be inhibited when the mother has a critical illness that produces barriers to parenting. It is important for nurses to recognize and eliminate common barriers to parenting that occur for the mother in the intensive care unit.

Diabetic ketoacidosis during pregnancy.

Pregnancy increases the chances for the woman with type 1 diabetes to develop DKA, especially if the patient is noncompliant with glycemic control, if a concomitant infection occurs, or if tocolysis with a beta-adrenergic agent is necessary for preterm labor. Prompt recognition of the crisis state of DKA with immediate intervention and management is a challenge for the health care team. Approaches to correct the fluid imbalance and to restore glucose homeostasis are needed to stabilize the patient and to provide an optimum outcome for mother and fetus. The critical assessment skills of the nurse, as well as the skills to provide the emotional aspects of care, are essential for a rapid resolution of the condition.

Humanizing the intensive care unit experience.

When the pregnant woman becomes critically ill, it is essential that she and her fetus receive the care that a specialized intensive care unit (ICU) provides. This unit is the setting for an expert medical, nursing, and technical staff to use sophisticated, state-of-the-art equipment for intensive monitoring and the immediate life-saving interventions that may be necessary. However, care in an ICU sometimes becomes focused on the machinery, rather than on the patient. It is imperative that the humanizing aspects of critical care be addressed in caring for a pregnant patient and her family. Obstetric critical care can benefit from the data in the critical care literature that addresses family and patient needs in an ICU. Obstetric literature and past experiences in implementing family-centered maternity care also can be used to identify the need for humane care and to enhance the ICU experience.

Trauma during pregnancy.

The active roles assumed by most pregnant women today put them at risk for vehicular accidents, falls, industrial accidents, violence, and other injuries. Trauma during pregnancy increases the maternal and fetal mortality and morbidity risks. Knowledge of the physiology of pregnancy is essential to establishing priorities and providing optimum care for the woman and fetus. Assessments and care from trauma and obstetric perspectives are essential; however, treatment priorities for the pregnant trauma patient are the primary consideration and are identical to those for nonpregnant trauma patients. Pregnancy does not limit or restrict any resuscitative, diagnostic, or pharmacologic treatment indicated after trauma. Fetal survival is dependent on maternal survival, so the woman must receive immediate intervention and condition stabilization for optimum fetal outcome.