Clinical ‘pearls’ of maternal critical care Part 2: sickle-cell disease in pregnancy

Purpose of review: The current review outlines the challenges in managing pregnant women with sickle-cell anemia, who are at risk of becoming critically ill during pregnancy. Recent findings: Sickle obstetric patients pose unique challenges to the anesthetist and intensivist. We discuss the role of prophylactic transfusions for specific indications like acute anemia and twin pregnancies. The management and prevention of vaso-occlusive crises and chest crisis are also outlined. The role of the multidisciplinary team cannot be overstated. Massive obstetric hemorrhage in this population is difficult, and unique considerations such as cell-saver technology and tranexamic acid usage are discussed. Secondary complications such as pulmonary hypertension and stroke are also considered, with a summary of the latest treatment guidelines. Summary: This is a challenging cohort of pregnant patients who have a significantly increased morbidity and mortality. This review aims to aid management of these patients on the labor ward for both obstetric anesthetists and intensivists.
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jeanette R. Bauchat Source Type: research

Related Links:

Hereditary hemorrhagic telangiectasia (HHT), a genetic bleeding disorder leading to systemic arteriovenous malformations (AVMs), is caused by loss-of-function mutations in the ALK1/ENG/Smad1/5/8 pathway. Evidence suggests that HHT pathogenesis strongly relies on overactivated PI3K/Akt/mTOR and VEGFR2 pathways in endothelial cells (ECs). In the BMP9/10-immunoblocked (BMP9/10ib) neonatal mouse model of HHT, we report here that the mTOR inhibitor, sirolimus, and the receptor tyrosine kinase inhibitor, nintedanib, could synergistically fully block, but also reversed, retinal AVMs to avert retinal bleeding and anemia. Sirolimus...
Source: Journal of Clinical Investigation - Category: Biomedical Science Authors: Source Type: research
Signaling by the TGF-β superfamily is important in the regulation of hematopoiesis and is dysregulated in myelodysplastic syndromes (MDSs), contributing to ineffective hematopoiesis and clinical cytopenias. TGF-β, activins, and growth differentiation factors exert inhibitory effects on red cell formation by activating canonical SMAD2/3 pathway signaling. In this Review, we summarize evidence that overactivation of SMAD2/3 signaling pathways in MDSs causes anemia due to impaired erythroid maturation. We also describe the basis for biological activity of activin receptor ligand traps, novel fusion proteins such as ...
Source: Journal of Clinical Investigation - Category: Biomedical Science Authors: Source Type: research
Leptomeningeal anastomoses or pial collateral vessels play a critical role in cerebral blood flow (CBF) restoration following ischemic stroke. The magnitude of this adaptive response is postulated to be controlled by the endothelium, although the underlying molecular mechanisms remain under investigation. Here we demonstrated that endothelial genetic deletion, using EphA4fl/fl/Tie2-Cre and EphA4fl/fl/VeCahderin-CreERT2 mice and vessel painting strategies, implicated EphA4 receptor tyrosine kinase as a major suppressor of pial collateral remodeling, CBF, and functional recovery following permanent middle cerebral artery occ...
Source: Journal of Clinical Investigation - Category: Biomedical Science Authors: Source Type: research
Review of English-language articles published from PubMed (MEDLINE) and Google Scholar between January 1, 1985, and January 1, 2019.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Crescendo transient ischemic attacks should be treated by carotid endarterectomy within two days – but with increased perioperative stroke risk Source Type: research
Multicenter retrospective analysis of patients entered in the prospective, randomized International Carotid Stenting Study between May 2001 and October 2008.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Open-cell stents used for carotid artery stenting are less likely to develop recurrent stenosis than closed-cell stents Source Type: research
Currently there is no definitive level I evidence regarding the appropriate management of asymptomatic moderate to severe carotid artery stenosis in the octogenarian patient. In this 5-year review of National Surgical Quality Improvement Program registry data, exceptional “real-world” results are reported with use of carotid endarterectomy (CEA) in this growing cohort.1 The combined stroke and death rate was 2% at 30-day follow-up (stroke rate 1%!), with the authors stating that “age alone should not interdict this modality.”
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Invited commentary Source Type: research
Regional anesthesia (RA)-induced vasodilation increases the proportion of patients with vein anatomy suitable for arteriovenous fistula (AVF) creation. The functional outcomes of AVFs created with veins initially small for size on preoperative duplex ultrasound mapping ( ≤2.4 mm) that are recruited under RA have not been clearly defined. We aimed to evaluate freedom from revision or thrombosis, time to first cannulation, and reintervention rates of AVFs created with veins recruited after induction of RA.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Clinical research study Source Type: research
Suprarenal abdominal aortic coarctation (SAAC) is a congenital midaortic syndrome that develops owing to a developmental anomaly in the fusion of the embryonic dorsal aortae. This condition is associated with severe hypertension, which is usually the indication for intervention. Open surgery is the primary treatment and it typically involves thoracoaortic bypass (TAB), and less commonly patch aortoplasty (PA). Bypass to the visceral vessels has also been performed in conjunction with TAB or PA. The majority undergoing intervention for SAAC are children and adolescents; therefore, the benefits of surgical intervention must ...
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Invited commentary Source Type: research
Authors: BaHammam AS, Almeneessier AS Abstract Previous studies have assessed the role of gender and menopause in Obstructive Sleep Apnea (OSA). It is well known that menopause is a major risk factor for OSA. However, analogous studies on obesity Hypoventilation Syndrome (OHS) are limited. Recent studies have suggested that OHS is more prevalent in postmenopausal women. Moreover, women with OHS seem to have excess comorbidities, including hypothyroidism, hypertension, pulmonary hypertension, and diabetes mellitus, compared to men. In the present perspective, we discuss recent data on the prevalence and comorbiditie...
Source: Open Respiratory Medicine Journal - Category: Respiratory Medicine Tags: Open Respir Med J Source Type: research
75 years old patient, with controlled diabetes and hypertension, very fit. he underwent in 2009, a radical prostatectomy followed 30 fractions of adjuvant 3D conformal radiation therapy to the prostatic bed only. in 2018: PSA rise to 2.16 2019: PSA 2.16 Pet PSMA showed a 7 mm LN at the level of L4-5 secondary lesion, with no recurrence in the tumor bed, neither in bone or other LNs. He was put on decapeptyl + casodex. please vote the poll
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Radiation Oncology Source Type: forums
More News: Anemia | Anesthesia | Anesthesiology | Hemorrhagic Stroke | Hypertension | OBGYN | Pregnancy | Pulmonary Hypertension | Sickle Cell Anemia | Stroke | Women