Articles  |   June 2019
SEE Question
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Cardiovascular Anesthesia / Obstetric Anesthesia / Pain Medicine / Pharmacology / Articles
Articles   |   June 2019
SEE Question
ASA Monitor 6 2019, Vol.83, 52-54.
ASA Monitor 6 2019, Vol.83, 52-54.
You are about to provide anesthesia to a 25-year-old parturient at 37 weeks’ gestation who is undergoing external cephalic version (ECV) for breech presentation. You recommend combined spinal-epidural anesthesia for the procedure. According to a recent trial comparing the effectiveness of increasing doses of intrathecal bupivacaine (2.5–10 mg) for ECV, which of the following is most likely true?
When a parturient undergoes a primary cesarean delivery, the likelihood is approximately 90 percent that a subsequent pregnancy will result in another cesarean delivery. Breech fetal presentation, with a prevalence of 3.8 percent for singleton pregnancies at term, increases the likelihood of cesarean delivery. However, this may be prevented through ECV. ECV is achieved by manual rotation of a fetus from breech to vertex presentation prior to the onset of labor. Previous studies have reported that neuraxial analgesia increases the success rate of ECV, presumably through reduction in maternal pain and relaxation of abdominal musculature. In addition, a meta-analysis has suggested improved success rates of ECV with increasing local anesthesia doses. It has been previously shown that neuraxial analgesia for ECV does not increase version-related complications including fetal bradycardia, placental abruption, or emergency cesarean delivery. In this recent randomized, double-blind trial, investigators compared the efficacy of increasing doses of spinal bupivacaine used for ECV. They hypothesized that larger doses would be associated with higher ECV success rates.
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