Abstract:
:Maternal haemorrhage is the leading cause of preventable maternal death worldwide and encompasses antepartum, intrapartum, and postpartum bleeding. This review highlights factors that predispose to severe bleeding, its management, and the most recent treatment and guidelines. Advances in obstetric care have provided physicians with the diagnostic tools to detect, anticipate, and prevent severe life-threatening maternal haemorrhage in most patients who have had prenatal care. In an optimal setting, patients at high risk for haemorrhage are referred to tertiary care centres where multidisciplinary teams are prepared to care for and deal with known potential complications. However, even with the best prenatal care, unexpected haemorrhage occurs. The first step in management is stabilization of haemodynamic status, which involves securing large bore i.v. access, invasive monitoring, and aggressive fluid management and transfusion therapy. Care for the patient with maternal bleeding should follow an algorithm that goes through a rapid and successive sequence of medical and surgical approaches to stem bleeding and decrease morbidity and mortality. With the addition of potent uterotonic agents and the advent of minimally invasive interventional radiological techniques such as angiographic embolization and arterial ligation, definitive yet conservative management is now possible in an attempt to avoid hysterectomy in patients with severe peripartum bleeding. If these interventions are inadequate to control the bleeding, the decision to proceed to hysterectomy must be made expeditiously. Recombinant factor VIIa is a relatively new treatment that could prove useful for severe coagulopathy and intractable bleeding.
journal_name
Br J Anaesthjournal_title
British journal of anaesthesiaauthors
Walfish M,Neuman A,Wlody Ddoi
10.1093/bja/aep303subject
Has Abstractpub_date
2009-12-01 00:00:00pages
i47-56eissn
0007-0912issn
1471-6771pii
S0007-0912(17)33864-3journal_volume
103 Suppl 1pub_type
杂志文章,评审abstract:BACKGROUND:Ketamine is widely used as an i.v. anaesthetic agent and as a drug of abuse. Hepatocytes contribute to the metabolism of endogenous and exogenous substances. This study evaluated the toxic effects of S-(+)-ketamine and possible mechanisms using human hepatoma HepG2 cells as the experimental model. METHODS:H...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aen322
更新日期:2009-01-01 00:00:00
abstract:Background:. Missense variants in the ryanodine receptor 1 gene ( RYR1 ) are associated with malignant hyperthermia but only a minority of these have met the criteria for use in predictive DNA diagnosis. We examined the utility of a simplified method of segregation analysis and a functional assay for determining the pa...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aex042
更新日期:2017-04-01 00:00:00
abstract::We studied 60 patients undergoing operation on the kidney with combined general and epidural anaesthesia, in a double-blind, randomized, controlled study. Patients were allocated to receive a preoperative bolus dose of ketamine 10 mg i.v., followed by an i.v. infusion of ketamine 10 mg h-1 for 48 h after operation, or...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/81.5.707
更新日期:1998-11-01 00:00:00
abstract::We studied 100 healthy women undergoing outpatient gynaecological laparoscopy in a randomized, double-blind and placebo-controlled study to evaluate the effect of neostigmine on postoperative nausea and vomiting (PONV). After induction of anaesthesia with propofol, anaesthesia was maintained with sevoflurane and 66% n...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/81.5.757
更新日期:1998-11-01 00:00:00
abstract::Blood samples were obtained from a radial artery cannula in a 60-yr-old man during coronary artery surgery. Serum potassium concentrations of 9.3, 8.4, and 7.4 mmol litre(-1) were obtained. A simultaneous venous blood sample gave a serum potassium concentration of 4.4 mmol litre(-1). The ECG was unchanged. After the a...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeh199
更新日期:2004-09-01 00:00:00
abstract::A combination of exogenous surfactant and partial liquid ventilation (PLV) with perfluorocarbons should enhance gas exchange, improve respiratory mechanics and reduce tissue damage of the lung in acute lung injury (ALI). We used a small dose of exogenous surfactant with and without PLV in an experimental model of ALI ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/87.4.593
更新日期:2001-10-01 00:00:00
abstract::Percutaneous dilatational tracheostomy (PDT) is associated with a number of life-threatening complications. We present a case of massive and fatal arterial haemorrhage that occurred in the intensive care unit during an elective PDT on an 86-year-old woman following earlier evacuation of a traumatic subdural haematoma....
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeg074
更新日期:2003-04-01 00:00:00
abstract::We have examined the role of benzodiazepine receptors in nitrous oxide-induced neuronal depression in rats. The changes in neuronal excitability induced by nitrous oxide and the benzodiazepine inverse agonist, Ro15-4513, were monitored by measurement of visual evoked potentials (VEP). Administration of Ro15-4513 10 mg...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/77.4.522
更新日期:1996-10-01 00:00:00
abstract::Ropivacaine is considered safer than bupivacaine, on the basis of experimental and human data that indicate a lower systemic toxicity. Here we report the occurrence of a single seizure after i.v. administration of ropivacaine 120 mg intended for extradural block in a patient having postpartum, tubal ligation. The only...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/80.6.843
更新日期:1998-06-01 00:00:00
abstract:BACKGROUND:Pain on injection of propofol is unpleasant. We hypothesized that propofol infusion pain might be prevented by infusing remifentanil before starting the propofol infusion in a clinical setting where target-controlled infusions (TCI) of both drugs were used. A prospective, randomized, double-blind, placebo-co...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aem293
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND:One-lung ventilation (OLV) increases mechanical stress in the lung and affects ventilation and perfusion (V, Q). There are no data on the effects of OLV on postoperative V/Q matching. Thus, this controlled study evaluates the influence of OLV on V/Q distribution in a pig model using a gamma camera technique ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aen021
更新日期:2008-04-01 00:00:00
abstract:BACKGROUND:The Alaris AEP monitor(TM) (Alaris, UK, version 1.4) is the first commercially available auditory evoked potential (AEP) monitor designed to estimate the depth of anaesthesia. It generates an "Alaris AEP index" (AAI), which is a dimensionless number scaled from 100 (awake) to 0. This study was designed to co...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeg189
更新日期:2003-09-01 00:00:00
abstract:Background:Experimental studies suggest that mechanical cell washing to remove pro-inflammatory components that accumulate in the supernatant of stored donor red blood cells (RBCs) might reduce inflammation and organ injury in transfused patients. Methods:Cardiac surgery patients at increased risk of large-volume RBC ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1093/bja/aex083
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:The analgesia/nociception index (ANI), a 0-100 non-invasive index calculated from heart rate variability, reflects the analgesia/nociception balance during general anaesthesia. The aim of this study was to evaluate the ANI in the assessment of immediate postoperative pain in adult patients undergoing general...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aet110
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:We investigated the effects of total i.v. anaesthesia (TIVA) and balanced anaesthesia (BAL) with sevoflurane on postoperative lung function in patients undergoing surgery in the prone position. METHODS:Sixty patients, aged 21-60 yr, undergoing elective lumbar disc surgery in the prone position were randomly...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aeq321
更新日期:2011-02-01 00:00:00
abstract::We have examined the effects of morphine in auricular myocardium from non-failing and failing human hearts. In both preparations morphine induced inhibition. These responses were not antagonized by naloxone. Comparison of mean IC30 values obtained in non-failing (3.9 (SEM 0.2) x 10(-8) mol litre-1) and failing (5010 (...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/76.1.106
更新日期:1996-01-01 00:00:00
abstract::Forty patients (age range 60-79 yr) undergoing transurethral surgery were allocated randomly to receive 0.5% plain bupivacaine 4 ml at the L2-3 (n = 20) or L4-5 (n = 20) space. The solution was injected over 30 s with the patient in the sitting position. The patient was kept sitting for 2 min, then placed supine and, ...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/64.2.170
更新日期:1990-02-01 00:00:00
abstract::Midazolam is often used for paediatric premedication. We have compared two methods of administering midazolam intranasally in 44 surgical day-case children allocated randomly to receive midazolam 0.2 mg kg-1 as drops or midazolam 0.1 mg kg-1 from an intranasal spray device. Behaviour was recorded on a four-point scale...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/81.6.865
更新日期:1998-12-01 00:00:00
abstract::Sepsis is a constellation of clinical signs and symptoms resulting from excessive systemic host inflammatory response to infection. This inflammatory response is largely mediated by cytokines, which are released into the systemic circulation. Plasma concentrations of specific cytokines, TNF alpha, IL-1 beta, IL-6 and ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,评审
doi:10.1093/bja/77.1.110
更新日期:1996-07-01 00:00:00
abstract::We have measured in 38 patients the plasma concentration profile of atracurium and its effect on the electromyographic first response of the train-of-four. One of three techniques was used to supplement anaesthesia with 66% nitrous oxide in oxygen, 0.9% isoflurane (end-tidal), 0.5% halothane (end-tidal) or midazolam 3...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章
doi:10.1093/bja/70.1.38
更新日期:1993-01-01 00:00:00
abstract::In a prospective randomized multi-centre study, the mortality following internal fixation surgery for fracture of the upper femur was investigated in 538 elderly patients allocated to receive subarachnoid blockade or general (narcotic-relaxant) anaesthesia. The 28-day mortality was 6.6% with subarachnoid, and 5.9% wit...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/59.9.1080
更新日期:1987-09-01 00:00:00
abstract::The effects of doxacurium chloride, a new long-acting non-depolarizing neuromuscular blocking drug, on cardiac performance were studied in 45 patients undergoing high-dose fentanyl-diazepam-oxygen anaesthesia for cardiac surgery. Data were collected at baseline (10 min after tracheal intubation), and at 2, 5 and 10 mi...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/63.6.675
更新日期:1989-12-01 00:00:00
abstract::We have measured the n-octanol/water distribution coefficients at 37 degrees C of two steroidal myoneural blockers (pancuronium and vecuronium) and of their 3-hydroxy metabolites over a pH range from 1.5 to 11. Pancuronium was found not to be lipid soluble. The mean distribution coefficient of 3-hydroxy vecuronium at ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/70.5.579
更新日期:1993-05-01 00:00:00
abstract::The interaction of three new non-depolarizing neuromuscular blocking agents--atracurium, vecuronium and Duador--on human red cell acetylcholinesterase (AChE; EC 3.1.1.7) and human plasma butyrylcholinesterase (BuChE; EC 3.1.1.8) was investigated. The binding of these neuromuscular blockers to human plasma proteins (pr...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:
更新日期:1983-01-01 00:00:00
abstract::The circulating blood volume (CBV) of critically ill patients may be difficult to estimate on the basis of history and physical examination. The aim of this study was to evaluate the ability of seven clinical signs and central venous pressure (CVP) to predict CBV in critically ill patients; CBV was evaluated with the ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/86.6.754
更新日期:2001-06-01 00:00:00
abstract::The effect of the intrathecal administration of diamorphine on the hyperglycaemic, adrenocortical and cardiovascular responses to major colonic surgery were investigated, and the results compared with those obtained in a similar group of patients receiving low doses of fentanyl. In the group receiving intrathecal diam...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/57.4.389
更新日期:1985-04-01 00:00:00
abstract:BACKGROUND:Arterial cannulation is a common anaesthetic procedure that can be challenging and time-consuming in small children. By visualizing the position of the radial artery, near-infrared vascular imaging systems (NIRVISs) might be of assistance in arterial cannulation. The present study evaluates the effectiveness...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aes193
更新日期:2012-09-01 00:00:00
abstract::Sickle cell disease is a congenital haemoglobinopathy with a high incidence of perioperative complications. Traditional anaesthetic management, based largely on extrapolation from biochemical models, has emphasized avoidance of red cell sickling to prevent exacerbations of the disease. This historical review outlines ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,评审
doi:10.1093/bja/aei129
更新日期:2005-09-01 00:00:00
abstract::The effects of i.m. dexmedetomidine 1.0 micrograms kg-1, a new alpha 2-adrenoceptor agonist, were compared with those of i.m. midazolam 0.08 mg kg-1 and placebo on vigilance, anaesthetic requirements, haemodynamic state and plasma catecholamine concentrations in a double-blind placebo-controlled study in 107 healthy (...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/67.4.402
更新日期:1991-10-01 00:00:00
abstract:BACKGROUND:It was hypothesized that xenon would stabilize mean arterial pressure (MAP) in haemorrhagic shock, recovery, and volume resuscitation, because a higher MAP has been observed with xenon, when compared with isoflurane anaesthesia. The responses to haemorrhage and subsequent volume replacement were therefore co...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aei127
更新日期:2005-06-01 00:00:00