Anaesthesia for parturients with severe cystic fibrosis: a case series.
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Affiliation
Department of Anaesthetics, National Maternity Hospital, Dublin, Ireland. Electronic address: maireadeighan@doctors.org.uk.Issue Date
2014-02MeSH
Adrenergic alpha-AgonistsAdult
Anesthesia, Epidural
Anesthesia, Obstetrical
Anesthesia, Spinal
Anesthetics, Local
Bupivacaine
Cesarean Section
Cystic Fibrosis
Epinephrine
Fatal Outcome
Female
Follow-Up Studies
Humans
Lidocaine
Pregnancy
Pregnancy Complications
Severity of Illness Index
Young Adult
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Anaesthesia for parturients with severe cystic fibrosis: a case series. 2014, 23 (1):75-9 Int J Obstet AnesthJournal
International journal of obstetric anesthesiaDOI
10.1016/j.ijoa.2013.10.006PubMed ID
24361190Abstract
Cystic fibrosis affects 1 in 1600-2500 live births and is inherited in an autosomal recessive manner. It primarily involves the respiratory, gastrointestinal and reproductive tracts, with impaired clearance of, and obstruction by, increasingly viscous secretions. Severe respiratory disease, diabetes and gastro-oesophageal reflux may result. Improvements in medical management and survival of cystic fibrosis patients means more are committing to pregnancies. Although guidance for anaesthesia in this patient group is available, management and outcome data associated with more severe cases are sparse. Patients with severe cystic fibrosis require multidisciplinary input and should be managed in a tertiary referral centre. Close monitoring of respiratory function and preoperative optimisation during pregnancy are mandatory. The risk of preterm labour and delivery is increased. Pregnancy and delivery can be managed successfully, even in patients with FEV1 <40% predicted. Neuraxial anaesthesia and analgesia should be the technique of choice for delivery. Postoperative care should be carried out in a critical care setting with the provision of postoperative ventilation if necessary.Item Type
ArticleLanguage
enISSN
1532-3374ae974a485f413a2113503eed53cd6c53
10.1016/j.ijoa.2013.10.006
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