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Managing Thromboembolism in Pregnancy

Thromboembolism is a leading cause of maternal morbidity and mortality in the United States. The risk of venous thromboembolism (VTE) is increased four-fold during pregnancy and another five-fold for 6 weeks following delivery. The increased VTE risk for these women is mainly attributed to pregnancy because it puts the body in an increased thrombogenic state, but physiologic factors, such as an enlarged uterus and compressed blood vessels at the time of childbirth, also play a role. Other risk factors include having a prior VTE, family history of thrombosis, smoking, high blood pressure, obesity, and operative delivery. The consequences of VTE during pregnancy can be severe and often stem from a failure in diagnosis rather than inadequate therapy. An updated practice bulletin from the American College of Obstetricians & Gynecologists (ACOG) was published in the September 2011 issue of Obstetrics & Gynecology to provide clinicians with updated information on the risk factors, diagnosis, management, and prevention of VTE. “This document places more emphasis on the acquired risk factors for VTE during pregnancy,” says Andra H. James, MD, who helped develop the bulletin. “The recommendations explain how to monitor women for thromboembolic events, address certain risk factors, and treat suspected or acute cases of VTE. The hope is that maternal deaths can be reduced if more clinicians adopt the recommendations provided in the bulletin.” New Recommendations to Manage VTE A major recommendation offered in the ACOG update is the use of compression ultrasonography of the proximal veins when signs or symptoms are suggestive of new onset DVT (Figure). Use of compression ultrasonography will indicate if treatment should be started or surveillance...

Conference Highlights: Anesthesiology 2011

The American Society of Anesthesiologists’ annual meeting, Anesthesiology 2011, held on October 15-19 in Chicago, was a comprehensive education program in anesthesiology, focusing on transforming patient safety through science and innovation. The news items below highlight just some of the studies that emerged from the meeting. » Less Propofol Required for Obese Children » Certain Behaviors Lead to Poor Pediatric Surgical Outcomes  » Identifying Women at Risk for Cesarean Pain » Risk Factors for Labor Pain » Anesthetics & Postoperative Delirium in the Elderly  Less Propofol Required for Obese Children The Particulars: The Particulars: Information regarding the appropriate doses for many anesthetics in obese children is lacking. Anesthesiologists must decide whether a dose should be based on actual or lean body weight in a population for whom 75% of excess body weight consists of drug distribution-altering fat tissue. Propofol can cause low blood pressure, prolonged sleepiness, and decreased breathing. Data Breakdown: Researchers measured responses in 40 obese and 40 non-obese children 20 seconds after they received propofol. To bring about unconsciousness at the beginning of surgery, obese children needed 2 mg/kg of propofol. Normal weight children required 3.2 mg/kg of propofol to bring about unconsciousness. Take Home Pearl: Obese children appear to require 50% to 60% less propofol than normal weight children to initiate anesthesia at the beginning of surgical procedures. Certain Behaviors Lead to Poor Pediatric Surgical Outcomes [back to top] The Particulars: Determining the coping, distress, and anxiety behaviors of children and their parents prior to surgery can be challenging during anesthesia induction and following surgery. The Perioperative Adult Child Behavioral Interaction Scale (PACBIS) is thought to provide real-time measurements for determining...
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