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Biomedical subjects

D H Chestnut

Publications and source records attributed to D H Chestnut.

84 records · Page 5Linked to original sources
PubMed1986

Effect of anesthesia for primary cesarean section on postoperative infectious morbidity.

It has been stated that general anesthesia is a risk factor for postcesarean infectious morbidity. A retrospective review of 252 women who had undergone primary cesarean section at the University of Iowa Hospital was conducted. Regional anesthesia was successfully administered to 170 patients, and general anesthesia was administered to 82 patients. Patients receiving general anesthesia were more likely to be indigent, to receive a vertical skin incision, and to be transfused intraoperatively and/or postoperatively. There were no statistically significant differences between the two groups with regard to multiple indexes of postoperative fever or infection, including febrile morbidity, diagnosis of infection, use of therapeutic antibiotics, fever index, and postoperative hospital stay. General anesthesia, as administered to patients in the present series, did not increase the risk of infectious morbidity after primary cesarean section. However, our surgeons apparently were influenced by the choice of anesthetic technique when selecting a skin incision.

Anesthesia, Conduction↗
PubMed1985

Management of severe distress in a potentially anomalous preterm fetus.

Unless there is unequivocal evidence of a congenital anomaly incompatible with life, expeditious delivery should be offered to the patient whose potentially viable fetus is showing evidence of severe distress. The patient should be informed of the difficulties in interpreting diagnostic testing as well as both the immediate risks and future implications of vertical cesarean delivery. Our case further suggests that ultrasonographically and echocardiographically detected congestive heart failure may actually help confirm the diagnosis of fetal distress rather than necessarily identify an anatomic cardiac anomaly.

Adult↗
PubMed1985

Continuous epidural anesthesia for elective cesarean hysterectomy.

Continuous lumbar epidural anesthesia was the primary anesthetic technique used for 25 patients having elective cesarean hysterectomy at Duke University Medical Center during a 12 1/2-year interval. Seven patients (28%) with initially satisfactory epidural anesthesia required intraoperative induction of general orotracheal anesthesia because of patient discomfort and resultant suboptimal operating conditions. Careful patient selection and preparation, expertise in administering continuous epidural anesthesia, and understanding of the demands of the operative procedure are essential when planning epidural anesthesia for cesarean hysterectomy.

Adult↗
PubMed1985

Peripartum hysterectomy: a review of cesarean and postpartum hysterectomy.

A retrospective review of 117 women who underwent peripartum hysterectomy at Duke University Medical Center during the past 21 years was conducted. Seventy-three cesarean hysterectomies were performed electively; 44 cesarean or postpartum hysterectomies were performed as emergencies. Statistically significant differences were noted between these groups in surgical technique, operative time, estimated blood loss, intraoperative hypotension, and intraoperative and total blood replacement. Additional significant differences were noted in postoperative febrile morbidity, use of therapeutic antibiotics, incidence of thromboembolic phenomena, and length of postoperative hospital stay. Separate analysis of elective cesarean hysterectomy patients revealed statistically significant decreases in operative time, estimated blood loss, intraoperative and total blood replacement, and postoperative hospital stay in the group having an experienced surgeon when compared with the group with less experienced surgeons.

Adolescent↗
PubMed1985

Nonbacterial thrombotic endocarditis associated with severe preeclampsia and pulmonary artery catheterization. A case report.

A pulmonary artery catheter was placed in a parturient whose 33-week gestation was complicated by severe preeclampsia and pulmonary edema. Cesarean delivery was performed for both maternal and fetal indications. During the second postoperative day the patient developed disseminated intravascular coagulation; subsequently she experienced sudden cardiopulmonary arrest and died. Autopsy revealed multiple pulmonary thromboemboli and trivalvular nonbacterial thrombotic endocarditis.

Adult↗
PubMed1985

Effect of anesthesia for repeat cesarean section on postoperative infectious morbidity.

It has been suggested that general anesthesia is a risk factor for postcesarean infectious morbidity. A retrospective review of 206 women who underwent repeat cesarean delivery at Duke University Medical Center was conducted. Group 1 consisted of 106 patients whose repeat cesarean section was performed with regional anesthesia, and group 2 included 100 patients whose repeat cesarean section was performed with general anesthesia. Group 2 patients were more likely to be of low socioeconomic status. There were no statistically significant differences between the two groups with regard to multiple indexes of postoperative fever or infection, including febrile morbidity, diagnosis of infection, use of therapeutic antibiotics, fever index, and postoperative hospital stay. General anesthesia, as administered to patients in the present series, does not increase the risk of infectious morbidity after repeat cesarean delivery.

Adult↗
PubMedDate not supplied

Bolus maternal cocaine administration does not produce a large increase in fetal sheep cerebral cortical glutamate concentration.

Human cocaine use during pregnancy may result in postnatal neurologic dysfunction and abnormal behavior. L-Glutamate, the major excitatory neurotransmitter in the brain, plays an important role in cerebral cortical development. An optimal level of glutamate is required for normal neuronal development. We tested whether acute cocaine exposure produces large increases in glutamate release in the intact cerebral cortex of the near-term fetal sheep. Cocaine 3.0 mg kg(-1) IV bolus produced the expected increase in maternal and fetal mean arterial pressure, increase in fetal heart rate, decrease in uterine blood flow, and decrease in fetal arterial blood pO2 (N = 5). The percentage increases in extracellular glutamate concentration in the fetal cerebral cortex measured by in utero microdialysis were 7%, 15%, 17%, 17%, and 43% in each fetus (upper 95% confidence bound for the median = 43%). We conclude that if cocaine increases glutamate concentration in the developing cerebral cortex, the increase in magnitude is small relative to the changes produced by other interventions such as ethanol or umbilical cord occlusion. Mechanisms other than increases in cerebral cortical glutamate concentration probably contribute to the neurologic injury associated with prenatal cocaine exposure.

Animals↗
PubMedDate not supplied

Does epidural analgesia during labor affect the incidence of cesarean delivery?

There is substantial evidence that there is an increased incidence of cesarean delivery among patients who receive epidural analgesia during labor. The controversy as to whether there is a causal relationship between epidural analgesia and cesarean delivery. Two prospective, randomized studies suggest that epidural analgesia may increase the incidence of operative delivery in laboring women. However, retrospective population-based studies suggest that the introduction of an epidural analgesia service, or the increased use of epidural analgesia, does not increase the cesarean delivery rate. It is possible that epidural analgesia during labor may increase the risk of cesarean delivery in selected patients. Such an effect--if it exists at all--appears to be small in contemporary practice. Furthermore, the availability and use of epidural analgesia may encourage other patients to undergo an adequate trial of labor or attempt vaginal birth after cesarean delivery. It is important to consider the impact of epidural analgesia on the total population of obstetric patients. Maternal-fetal factors and obstetric management, not epidural analgesia, are the most important determinants of the cesarean delivery rate. Finally, physicians should remember that pain relief is itself a worthy goal.

Anesthesia, Epidural↗