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Biomedical subjects

G F Marx

Publications and source records attributed to G F Marx.

At least 55 records · Page 3Linked to original sources
PubMed1988

Anaesthetic management of a parturient with prior myocardial infarction and coronary artery bypass graft.

An increasing number of parturients suffering from ischaemic heart disease require anaesthetic care for labour and vaginal delivery. We present the case of a 42-year-old gravida who had previously suffered a myocardial infarction and undergone coronary artery bypass grafting. Management was directed toward prevention of haemodynamic instability by alleviation of pain and stress while minimizing the risk of anaesthetic complications. Monitoring included a central venous catheter, pulse oximetry, and an automated blood pressure cuff. A judiciously administered segmental lumbar extradural block was instituted early, utilizing local anaesthetics with the narcotic fentanyl.

Adult↗
PubMed1987

Potential hazards of hypoglycaemia in the parturient.

Hypoglycaemia can cause serious problems in anaesthetized patients, due to blockade by anaesthesia of the usual compensatory mechanisms. Gravid women develop hypoglycaemia more readily than non-pregnant patients because they live in a state of "accelerated starvation." Three cases are described of healthy parturients undergoing elective Caesarean section under lumbar epidural analgesia whose post-blockade hypotension was difficult to reverse until their low blood glucose concentrations had been normalized. Further investigations of the role played by blood glucose concentrations in the maintenance of cardiovascular homeostasis in pregnant women are indicated. In the meantime, a preanaesthetic blood glucose determination will facilitate measures to ensure a normal blood glucose level before induction of anaesthesia for Caesarean section.

Adult↗
PubMed1987

Neonatal status in relation to incision intervals, obstetric factors, and anesthesia at cesarean delivery.

Uterine incision to delivery interval has been suggested as a critical determinant of neonatal outcome; however, studies of skin incision and uterine incision to delivery intervals have usually not analyzed the contribution of obstetric factors relative to time factors in determining outcome. A group of 204 patients undergoing cesarean delivery were studied. Stepwise multivariate regression was used to examine the relative contribution of obstetric and anesthetic factors to Apgar scores and umbilical cord blood gases. Apgar scores and umbilical cord blood gases were significantly influenced by labor complications (fetal distress, meconium, and pre-eclampsia), infant weight, type of cesarean delivery (primary vs. repeat), and type of anesthesia. Skin incision and uterine incision to delivery intervals did not significantly contribute to Apgar scores nor umbilical cord blood gases when corrected for these factors. We conclude that careful attention to maternal status prior to cesarean delivery and optimal anesthetic management appear to be the most important factors for good neonatal outcome. Surgical techniques should be directed at gentle, atraumatic delivery of the fetus for the good of the fetus and the mother.

Anesthesia, Obstetrical↗
PubMed1987

[Historical development of obstetrical anesthesia].

Pain is a primary component of normal childbirth as evidenced by the behavior of parturients in primitive societies. Methods of pain relief such as the use of herbs and plant extracts were described in ancient writings. Modern obstetric analgesia employing ether began in 1847, three months after the first successful surgical anesthetic. Administration of chloroform and nitrous oxide followed. Twilight sleep, a combination of morphine and scopolamine, became popular in the beginning of the twentieth century as did regional analgesia, first single injection and later continuous blockade via catheter. Simultaneously, psychologic methods were propagated, but were not uniformly successful. Continuous lumbar extradural analgesia has evolved as the optimal method of bsotetric pain relief, both subjectively and objectively, and its combination with childbirth education is considered to be complementary. The increasing utilization of obstetric analgesia and the recognition of marked physiologic and pharmacologic differences between pregnant and nonpregnant patients has led to the development of the subspecialty of obstetric anesthesia as well as to the foundation of obstetric anesthesia societies.

Anesthesia, Obstetrical↗
PubMed1986

Umbilical blood flow velocity waveforms in different maternal positions and with epidural analgesia.

Umbilical blood flow velocity waves were measured in the fetuses of healthy parturients in early active labor to assess the influence of different maternal positions (N = 16) and of epidural analgesia (N = 16). The ratio of systolic peak to diastolic trough (S/D) of the umbilical blood flow velocity wave is reflective of vascular resistance distal to the point of measurement on the fetal side of the placenta. Umbilical blood flow velocity wave S/D ratios were significantly higher in the supine than in either lateral position indicating that umbilical artery vascular resistance is increased when the mother lies supine. After epidural blockade, the S/D ratios were unchanged in three and lowered to varying degrees in 13 parturients indicating that this method of pain relief beneficially affects umbilical artery vascular resistance.

Anesthesia, Epidural↗
PubMed1984

Fetal-neonatal status following caesarean section for fetal distress.

Fetal biochemical and neonatal clinical data were compiled in 126 emergency Caesarean sections performed for fetal distress. The choice of anaesthetic technique was determined by the wishes of the mother. General anaesthesia was administered to 71 parturients and regional analgesia to 55 (subarachnoid block 33, extension of extradural block 22). The aetiologies of fetal distress and the skin incision-delivery and uterine incision-delivery intervals were not significantly different between the two anaesthesia groups. Umbilical artery blood pH values were higher than the last scalp capillary blood pH values in 63% of the general anaesthesia and in 80% of the regional analgesia cases. Umbilical vein and artery blood-gas and pH data were similar in the two anaesthesia groups, but 1-min Apgar scores were significantly better following regional analgesia. Despite the presence of fetal distress, subarachnoid blockade was a most suitable method of anaesthesia in experienced hands.

Anesthesia, Conduction↗
PubMed1983

Pharyngolaryngeal edema as a presenting symptom in preeclampsia.

Pharyngolaryngeal edema, a rare and serious complication of obstetric anesthesia, was associated with preeclampsia in four of seven reported cases. The authors treated two severely preeclamptic women with this complication who required general anesthesia for cesarean section. In both women, gentle direct laryngoscopy under topical anesthesia of the oropharynx was undertaken to detect possible difficulty in endotracheal intubation. Based on the findings at laryngoscopy, one patient was intubated while awake and breathing spontaneously. The other patient could be managed safely in the usual manner. Postoperatively, both women were nursed in an intensive care unit until after the airway problem had subsided.

Adult↗