Background: and Purpose To evaluate the outcome events and bleeding complications of the European Society of Cardiology (ESC) guideline-matched oral anticoagulant therapy for patients with acute ischemic stroke and atrial fibrillation (AF). Methods: Patients with acute ischemic stroke and AF from a nationwide multicenter registry (Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts [K-ATTENTION]) between January 2013 and December 2015 were included in the study. Patients were divided into the ESC guideline-matched and the non-matched groups. The primary outcome was recurrence of any stroke during the 90-day follow-up period. Secondary outcomes were major adverse cerebrovascular and cardiovascular events, ischemic stroke, intracranial hemorrhage, acute coronary syndrome, allcause mortality, and major hemorrhage. Propensity score matching and logistic regression analyses were performed to assess the effect of the treatments administered. Results: Among 2,321 eligible patients, 1,126 patients were 1:1 matched to the ESC guidelinematched and the non-matched groups. As compared with the non-matched group, the ESC guideline-matched group had a lower risk of any recurrent stroke (1.4% vs. 3.4%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.18 to 0.95). The risk of recurrent ischemic stroke was lower in the ESC guideline-matched group than in the non-matched group (0.9% vs. 2.7%; OR, 0.32; 95% CI, 0.11 to 0.88). There was no significant difference in the other secondary outcomes between the two groups. Conclusions ESC guideline-matched oral anticoagulant therapy was associated with reduced risks of any stroke and ischemic stroke as compared with the non-matched therapy.

OBJECTIVES: To compare the clnical data of general and regional anesthesia for cesarean section in patients with systemic hypertension. METHODS: We conducted a retrospective survey with the medical records of the patients with hypertensive disorders in pregnancy, who under went cesarean section from January 1998 to December 2012. We collected data including patients' demographics, anesthesia and maternal and neonatal outcome. According to anesthetic method, the subjects were divided into general anesthesia and regional anesthesia group and the clinical outcome were compared. We reclassified the patients according to the use of magnesium sul fate (MgSO4) and compared the clinical outcomes. RESULTS: Of the 1,050 hypertensive parturients, 848 (80.8%) patients went through cesarean section. Three hundred and sixty three patients (42.8%) underwent epidural anesthesia, general and spinal anesthesia were used in 268 (31.6%), and 217 (25.6%) patients, respectively. There was no significant difference in maternal and neonatal outcome according to anesthetic method. In the patients administered MgSO4, 1 minute Apgar score was lower and maternal gestational age and birth weight were less than the patients not receiving MgSO4. CONCLUSION: Anesthetic methods did not have effect on outcome of cesarean section of the patients with hypertensive disorder of pregnancy.
Anesthesia* ; Anesthesia, Conduction ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal ; Apgar Score ; Birth Weight ; Cesarean Section* ; Demography ; Female ; Gestational Age ; Humans ; Hypertension ; Magnesium ; Medical Records ; Pregnancy ; Pregnancy* ; Retrospective Studies*

Epidural analgesia is frequently used for control of labor pain. Seizure of parturient could be misdiagnosed as eclampsia. A parturient presented a generalized tonic clonic seizure during first stage of labor in two and a half hour after dural puncture and epidural blood patch. She had received an emergency cesarean section under general anesthesia and had another seizure during transfer to the intensive care unit. A brain computed tomography showed intracerebral hemorrhage and pneumocephalus. After conservative treatment, she could discharge without any sequelae in 13 days. The anesthesiologists should be aware of the possibility of intracerebral hemorrhage when they confront a seizure of parturient although there is no evidence of relation between dural puncture and intracerebral hemorrhage.
Analgesia, Epidural ; Anesthesia, General ; Blood Patch, Epidural ; Brain ; Cerebral Hemorrhage ; Cesarean Section ; Eclampsia ; Emergencies ; Female ; Intensive Care Units ; Labor Pain ; Pneumocephalus ; Pregnancy ; Punctures ; Seizures

OBJECTIVES: Maternal hypotension is a common problem during cesarean section under spinal anesthesia. We evaluated the influence of injection speed of local anesthetic to subarachnoid space on maternal hypotension and level of sensory block. METHODS: Bupivacaine (0.5%) 9 mg with fentanyl 10 microg was injected to subarachnoid space either quickly (during 20 seconds, 0.1 mL/sec, n=20) or slowly (during 100 seconds, 0.02 mL/sec, n=20) in parturients scheduled for elective cesarean section. The onset and level of sensory block was checked and heart rate and blood pressure was checked by 2.5 minutes during 20 minutes. Hypotension (systolic blood pressure <100 mmHg or <70% of baseline) was treated with ephedrine. RESULTS: Hypotension occurred 70% of parturients with spinal anesthesia. Slow injection didn't influence on the onset and level of sensory block and didn't reduce the incidence of hypotension. But onset of hypotension was delayed. CONCLUSION: Slow injection (during 100 seconds, 0.02 mL/sec) of local anesthetic delayed onset of hypotension and required less amount of ephedrine. Slow injection of local anesthetic was one of the effective methods for the cardiovascular stability during cesarean section under spinal anesthesia.
Anesthesia ; Anesthesia, Spinal ; Blood Pressure ; Bupivacaine ; Cesarean Section ; Ephedrine ; Female ; Fentanyl ; Heart Rate ; Hypotension ; Incidence ; Injections, Spinal ; Pregnancy ; Subarachnoid Space

Vasopressin is often used locally to reduce blood loss in gynecologic surgery. The use of local infiltration of low concentration vasopressin (0.05-0.3 units/ml) has been considered to be safe. However, serious side effects such as bradycardia, hypertension, arrhythmia, pulmonary edema, coronary vasospasm, myocardial infarction and even cardiac arrest were reported during low-dose vasopressin. In 2 healthy women with myoma and multiple myoma combined with adenomyosis, we experienced pulmonary edema after intramyometrial injection and paracervical infiltration of vasopressin. After diuretics and oxygen therapy, the patients were recovered without any complications.
Adenomyosis ; Arrhythmias, Cardiac ; Bradycardia ; Coronary Vasospasm ; Diuretics ; Female ; Gynecologic Surgical Procedures ; Heart Arrest ; Humans ; Hypertension ; Myocardial Infarction ; Myoma ; Oxygen ; Pulmonary Edema ; Vasopressins

BACKGROUND: The purpose of this study was to identify the effect of fentanyl dose on the onset and duration of 0.2% ropivacaine. METHODS: Sixty-one nulliparous women with singleton vertex pregnancy who requested epidural labor analgesia were enrolled. Patients were administered randomly 0, 50, 100microgram of fentanyl with 10 ml of 0.2% ropivacaine (Group F0, F50 and F100, respectively). VAS pain scores were recorded 0, 5, 10, 15 min after epidural injection, after which they were recorded every 15 min. The onset and duration of analgesia were measured. Side effects such as, pruritus, motor blockade, and hypotension were recorded.Satisfaction scores, type of delivery, and neonatal outcomes were recorded. RESULTS: The onset of analgesia was at 8.5 +/- 3.4 min in Group F100, compared with 13.7 +/- 7.2 min in Group F0 and 13.6 +/- 5.3 min in Group F50 (P = 0.009). The duration of analgesia was 122.6 +/- 20 min in Group F100, compared with 72.3 +/- 21.2 min in Group F0 and 97.8 +/- 22.4 min in Group F50 (P = 0.000). There were significant differences in VAS pain scores and satisfaction scores among the three groups. There were no differences in the incidences of maternal side effects and operative delivery or neonatal outcomes. CONCLUSION: Fentanyl 100microgram was the most appropriate dose when combined with 0.2% ropivacaine due to the rapid onset and long duration of epidural labor analgesia.
Amides ; Analgesia ; Female ; Fentanyl ; Humans ; Hypotension ; Incidence ; Injections, Epidural ; Pregnancy ; Pruritus

BACKGROUND: The effect of epidural analgesia for labor on obstetric outcome is controversial. The purpose of this study is evaluating the influence of epidural analgesia on cesarean section in nulliparous women. METHODS: We retrospectively investigated 979 nulliparous women ASA graded I - II. EPI (n = 230) was received epidural analgesia with 0.2% ropivacaine and 75microgram fentanyl. N-EPI (n = 749) was received no epidural analgesia but nalbuphine 10 mg intramuscularly. We compared the rate and causes of cesarean section, instrumental delivery rate and fetal outcomes between EPI and N-EPI. RESULTS: Cesarean section rate was not different between the EPI (18%) and N-EPI (23%). Causes of cesarean section were progress failure (83% in EPI and 80% in N-EPI) and fetal distress (17% in EPI and 20% in N-EPI) and there were no differences between two groups. Instrumental delivery rate was higher in EPI (8%) than N-EPI (5%). Fetal outcome was not different between two groups. CONCLUSIONS: Epidural analgesia did not increase cesarean section rate and did not influence on causes of cesarean section. But epidural analgesia increased the vacuum delivery rate.
Amides ; Analgesia, Epidural ; Cesarean Section ; Female ; Fentanyl ; Fetal Distress ; Humans ; Nalbuphine ; Pregnancy ; Retrospective Studies ; Vacuum

BACKGROUND: There are many difficulties in anesthetic management for cesarean section of the patients with hypertension.The anesthetic management of hypertensive disorders in pregnancy has been controversial. METHODS: We reviewed the medical records of the patients with hypertensive disorders in pregnancy from Jan., 1998 to Dec., 2007, and made clinical analysis of the anesthesia for cesarean section. RESULTS: Of the total 775 parturients with hypertensive disorders, 638 (82.3%) was delivered by cesarean section.Indications for cesarean section were, in order of frequency, hypertensive disorders in pregnancy (36.9%), multiple pregnancy (13.8%), previous cesarean section (11.6%), etc.Of the total cesarean section, 468 (73.4%) were emergency cases.The majority of preoperative systolic blood pressures were 141-160 mmHg (36.2%) and 161-180 mmHg (35.2%). The majority of preoperative diastolic blood pressures were 91-100 mmHg (28.6%) and 101-110 mmHg (25.0%). 350 (54.9%) had epidural anesthesia, 195 (30.5%) had general anesthesia, and 93 (14.6%) had spinal anesthesia.Estimated blood loss was significantly lower after regional anesthesia than after general anesthesia.In patients received magnesium sulfate (MgSO4), (40.0% of total) 83.5% had regional anesthesia and 16.5% had general anesthesia.In the cases with MgSO4 1 min Apgar score was lower and neonatal birth weight was smaller than in cases without MgSO4. CONCLUSIONS: Anesthesiologist must have much attention on the prevention, treatment and anesthetic management for cesarean section of patients with hypertensive disorders in pregnancy.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal ; Apgar Score ; Birth Weight ; Cesarean Section ; Emergencies ; Female ; Humans ; Magnesium Sulfate ; Medical Records ; Pregnancy ; Pregnancy, Multiple ; Retrospective Studies

A 35 year old multipara woman was admitted for emergency repeat cesarian section. She had first cesarian section under general anesthesia 3 years ago, and appendectomy under spinal anesthesia 2 years ago. But no uneventful problem developed in two cases of anesthesia. After induction of general anesthesia with propofol and succinylcholine, the patient showed irritability and severe cough, and immediate anaphylactic reaction developed with cardiovascular collapse, bronchospasm, and erythematous skin eruption. We resuscitated the patient with epinephrine and methylprednisolone but cesarian section was performed without delay. Four minutes after the induction of anesthesia female baby was delivered and the patient was recovered without any complication.
Anaphylaxis ; Anesthesia ; Anesthesia, General ; Anesthesia, Spinal ; Appendectomy ; Bronchial Spasm ; Cough ; Emergencies ; Epinephrine ; Female ; Humans ; Methylprednisolone ; Propofol ; Skin ; Succinylcholine