APACHE II: for one or for all?

“…[19][20][21][22] A role for laudanosine in neuroprotection has recently been proposed in anesthesia, since it was postulated that laudanosine, at clinical concentrations reported in CSF after administration of cisatracurium, could elicit a long-acting neuroprotective effect. 23,24 Taken together, experimental and clinical data indicate a potential and prolonged neuroprotective role for the metabolite laudanosine against cerebral hypoxia-ischemia in the perinatal period. The clinical relevance is that administration of the neuromuscular blocking drug cisatracurium could be potentially therapeutic for patient and fetus in obstetric anesthesia.…”

Section: In Replymentioning

confidence: 97%

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Fodale

Praticò

Leto

et al. 2005

International Journal of Obstetric Anesthesia

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With the stated dose (0.1 mg/kg) either it must have been necessary to assist ventilation to avoid desaturation while awaiting onset of adequate block for intubation, or intubation was performed without delay under conditions facilitated by the propofol bolus. I would regard neither approach as ideal in the obstetric patient.Although the authors wrote that neostigmine Ô2 mL' was given, I presume they meant 2 mg. Train-of-four neuromuscular stimulation was used, but, crucially, there is no documentation of a response (i.e. four twitches and absence of fade) that demonstrated complete reversal of neuromuscular block. I would be grateful if the authors would justify their choice of cisatracurium, and reassure me that their patients were fully reversed before extubation and the subsequent development of laryngospasm.

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Hypertensive Disorders in Pregnancy

Hurtado

Merchante

2022

Obstetric Anesthesia: Clinical Updates

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Due to the high risk of morbidity and mortality in pregnant women with unrecognised and untreated preeclampsia, a high index of suspicion for signs of preeclampsia should be used to evaluate, treat and monitor patients. Early blood pressure control and seizure prophylaxis during labour are essential to ensure maternal safety. However, a limited proportion of pregnancies and deliveries may present a wide range of complications that may require admission to a critical care unit (CCU). Hypertensive disorders of pregnancy and massive hemorrhage are among the most common causes of admission to the CCU in pregnant and post-partum women.

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APACHE II: for one or for all?

Cited by 3 publications

References 4 publications

Clinical characteristics and outcomes of obstetric patients admitted to the intensive care unit

Clinical characteristics and outcomes of obstetric patients admitted to the intensive care unit

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Hypertensive Disorders in Pregnancy

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