Analysis of Maternal and Fetal Oxidative Stress During Delivery with Epidural Analgesia.

Childbirth is a stressful event for mothers, and labor epidural analgesia (LEA) may reduce mental stress. Mental stressors include labor pain, fear, and anxiety, which induce oxidative stress. In this study, we focused on oxidative stress during delivery and conducted a cross-sectional analysis of maternal and fetal oxidative stress. The participants included 15 women who received LEA (LEA group) and 15 who did not (No LEA group). Participants with a gestational age of < 37 weeks, BMI of ≥ 35 kg/m2, cerebrovascular or cardiovascular complications, multiple pregnancies, gestational hypertension, gestational diabetes, chronic hypertension, thyroid disease, birth weight of < 2,500 g, emergency cesarean section, or cases in which epidural anesthesia was re-administered during delivery were excluded from the study. Maternal blood was collected on admission, and immediately after delivery, and umbilical artery blood was collected from the fetus. The oxidative stress status was assessed by measuring diacron-reactive oxygen metabolite (an index of the degree of lipid peroxide oxidation), biological antioxidant potential (an index of antioxidant capacity) and calculating the ratio of BAP/d-ROMs (an index of the oxidative stress). The results showed that maternal oxidative stress immediately after delivery was lower in the LEA group than in the No LEA group. Moreover, the fetuses experienced less oxidative stress in the LEA group than in the No LEA group. Taken together, these results suggest that LEA may reduce maternal and fetal oxidative stress associated with childbirth.

[Anesthetic management for cases of placenta accreta presented for cesarean section: a 7-year single-center experience].

BACKGROUND: Anesthetic management of cesarean section for placenta accreta is very challenging. The aim of our retrospective study was to review past placenta accreta cases in our hospital to suggest a strategy for anesthetic management for placenta accreta. METHODS: Placenta accreta cases were identified in our obstetric anesthesia data base. Their diagnosis, surgical procedure, amount of blood loss and anesthetic management were reviewed. RESULTS: Twenty-two cases of placenta accreta were identified. Of them 16 cases underwent cesarean hysterectomy. The amount of blood loss in the 22 cases ranged from 590 to 10500 ml. Neuraxial anesthesia alone was planned in 11 cases, 6 of which were converted to general anesthesia due to massive bleeding. In most of the cases, more than 2 large-bore intravenous lines and arterial line were placed prior to the beginning of surgery. All cases were well managed. CONCLUSIONS: We suggest the minimum requirements for anesthetic management in patients with placenta accreta as follows: (1) discussion with obstetricians to formulate a cesarean section plan, (2) early evaluation to formulate an anesthetic plan and to obtain informed consent, (3) two experienced anesthesiologists, (4) general anesthesia, (5) 2 large-bore intravenous lines, (6) an arterial line and (7) 10 units of both fresh frozen plasma and crossmatched packed red blood cells.

[Pain control by caudal epidural infusion in a pregnant woman with hemorrhoids carrying triplets].

A 30-year-old woman in her 25th week of gestation with triplets complained of severe pain due to a hemorrhoid. The patient felt it was difficult to continue childbearing. First we performed caudal epidural block with 0.25% bupivacaine 20 ml and morphine hydrochloride 2 mg once a day, for 12 days without inserting a catheter because there were signs of infection. After the signs of infection had disappeared, we inserted a caudal epidural catheter and administered 0.125% bupivacaine 1-2 ml x hr(-1) for 6 days, up to the day of cesarean section. Liver function and blood bupivacaine levels of the mother were acceptable in the perioperative periods. The babies' Apgar scores and neurologic findings of the babies were normal. Blood bupivacaine levels of the babies were below the limit of measurement.

[Anesthetic management of a patient with xeroderma pigmentosum].

Xeroderma pigmentosum (XP) is a rare autosomal recessive disease, which is characterized by hypersensitivity of the skin to ultraviolet (UV)-radiation and progressive neurological complications. Patients with XP show a failure to properly repair UV-induced DNA lesions by the nucleotide excision repair (NER) mechanism. This results predominantly in a high frequency of UV-induced skin tumors at an early age. Therefore, patients with XP must avoid exposure to UV-radiation by use of protective clothing, sunscreen and UV-blocking film. We report a 15-year-old girl, who underwent surgical treatment twice for clubfoot under general anesthesia using propofol and fentanyl. We protected her skin from light with UV blocking film in the operating room. Both surgical procedures were performed uneventfully except for delayed awakening. A number of precautions must be taken in the perioperative management of XP patients, which include proper shielding from damaging light, avoidance of all drugs that harm DNA such as halothane and careful evaluation of neurological abnormalities. There is a possibility of difficult endotracheal intubation or prolonged effect of muscle relaxation due to skin atrophy and joint contracture.