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Anesthetic Management of Nonobstetric Surgery during Pregnancy

Toledano, R. d\Arby; Madden, Hannah E.; Leffert, Lisa
ISI:000642449600006
ISSN: 1523-3855
CID: 5213182

Intracranial Lesions in Pregnancy

Chapter by: Toledano, Roulhac D; Leffert, Lisa
in: Obstetric anesthesiology : an illustrated case-based approach by Husain, Tauqeer; Fernando, Roshan; Segal, Scott (Eds)
Cambridge UK : University Printing House, 2019
pp. 253-256
ISBN: 9781107095649
CID: 5213132

Anesthetic and Obstetric Management of Placenta Accreta: Clinical Experience and Available Evidence

Toledano, Roulhac D; Leffert, Lisa R
Abnormally implanted, invasive, or adherent placenta has become one of the most serious problems in obstetrics, comprising a leading cause of maternal hemorrhage, the most common cause of peripartum hysterectomy and an increasingly important contributor to cesarean delivery morbidity. Currently, up to 3 in 1000 pregnancies in the USA are complicated by placenta accreta, increta, or percreta, and the incidence is increasing in parallel with the rising cesarean delivery rate. Yet, despite the high morbidity and mortality associated with placenta accreta, consensus guidelines are lacking regarding the management of women with this condition. This article reviews anesthetic and obstetric management of patients with placenta accreta based on clinician experience and the current literature, with emphasis on several controversial aspects of care, including timing of delivery, whether and when conservative obstetric management should be considered, the role of perioperative interventional radiology, and the risks and benefits of general versus neuraxial anesthesia. Antenatal diagnosis and multidisciplinary planning, when possible, with individualized consideration of patient preferences, are essential for the management of placenta accreta. Contingency plans for emergency delivery should be made for each patient and disseminated among all members of the multidisciplinary team
ORIGINAL:0011727
ISSN: 1523-3855
CID: 2437682

Epidural Anesthesia and Analgesia

Chapter by: Toledano, Roulhac D; Van de Velde, Marc
in: Hadzic's textbook of regional anesthesia and acute pain management by Hadzic, Admir (Ed)
New York : McGraw-Hill Education, [2017]
pp. 380-?
ISBN: 0071717595
CID: 2745612

Intracranial lesions in pregnancy

Chapter by: Toledano, Roulhac
in: Consults in Obstetric Anesthesiology by Mankowitz, Suzanne (Ed)
[S.l.] : Springer Verlag, 2017
pp. 361-364
ISBN: 3319596799
CID: 2745702

HIV in pregnancy

Chapter by: Toledano, Roulhac
in: Consults in Obstetric Anesthesiology by Mankowitz, Suzanne (Ed)
[S.l.] : Springer Verlag, 2017
pp. 277-281
ISBN: 3319596799
CID: 2745712

UpToDate, 2016-

Neuraxial analgesia for labor and delivery (including instrumented delivery)

Toledano, Roulhac d'Arby; Leffert, Lisa
(Website)
CID: 2152172

Physiological changes associated with pregnancy

Chapter by: Toledano, Roulhac
in: Oxford textbook of obstetric anaesthesia by Clark, Vicki [Eds]
[S.l.] : Oxford Univ Press, 2016
pp. 31-48
ISBN: 9780198713333
CID: 2297002

Complement factor B activation in patients with preeclampsia

Velickovic, Ivan; Dalloul, Mudar; Wong, Karen A; Bakare, Olufunke; Schweis, Franz; Garala, Maya; Alam, Amit; Medranda, Giorgio; Lekovic, Jovana; Shuaib, Waqas; Tedjasukmana, Andreas; Little, Perry; Hanono, Daniel; Wijetilaka, Ruvini; Weedon, Jeremy; Lin, Jun; Toledano, Roulhac d'Arby; Zhang, Ming
Preeclampsia is a leading cause of maternal and fetal morbidity and mortality. Bb, the active fragment of complement factor B (fB), has been reported to be a predictor of preeclampsia. However, conflicting results have been found by some investigators. We hypothesized that the disagreement in findings may be due to the racial/ethnic differences among various study groups, and that fB activation is significant in women of an ethnic minority with preeclampsia. We investigated the maternal and fetal levels of Bb (the activated fB fragment) in pregnant women of an ethnic minority with or without preeclampsia. We enrolled 291 pregnant women (96% of an ethnic minority, including 78% African-American). Thirteen percent of these were diagnosed with preeclampsia. Maternal venous blood was collected from all participants together with fetal umbilical cord blood samples from 154 deliveries in the 291 women. The results were analyzed using the Mann-Whitney U test and multivariate analyses. Maternal Bb levels were significantly higher in the preeclamptic group than in the nonpreeclamptic group. Levels of Bb in fetal cord blood were similar in both groups. Subgroup analyses of African-American patients' results confirmed the study hypothesis that there would be a significant increase in Bb in the maternal blood of the preeclamptic group and no increase in Bb in the fetal cord blood of this group. These results suggest that a maternal immune response through complement fB might play a role in the development of preeclampsia, particularly in African-American patients.
PMCID:4425571
PMID: 25604034
ISSN: 1872-7603
CID: 1890622

Epidural catheter design: history, innovations, and clinical implications [Historical Article]

Toledano, Roulhac D; Tsen, Lawrence C
Epidural catheters have evolved during the past several decades, as clinicians and manufacturers have sought to influence the quality of analgesia and anesthesia and reduce the incidence of catheter-related complications. This evolution has allowed a transformation from single-shot to continuous-infusion techniques and resulted in easier passage into the epidural space, more extensive medication distribution, and ultimately, improved patient satisfaction. Particular catheter features, including the materials used, tip design, and orifice number and arrangement, have been associated with specific outcomes and provide direction for future development.
PMID: 24681579
ISSN: 1528-1175
CID: 1890632