Anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Is combined spinal-epidural analgesia associated with more rapid cervical dilation in nulliparous patients when compared with conventional epidural analgesia?
The combined spinal-epidural technique provides rapid onset of labor analgesia and, anecdotally, is associated with labors of shorter duration. Epidural analgesia, by contrast, has been suggested to prolong labor modestly. It is unclear, however, whether more rapid cervical dilation in patients who receive combined spinal-epidural analgesia is a physiologic effect of the technique or an artifact of patient selection. The authors hypothesized that anesthetic technique may influence the rate of cervical dilation, and we compared the effects of combined spinalepidural with those of epidural analgesia on the rate of cervical dilation. ⋯ In healthy nulliparous parturients in early labor, combined spinal-epidural analgesia is associated with more rapid cervical dilation compared with epidural analgesia. Further study is needed to elicit the cause and overall effect of this difference.
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Comparative Study Clinical Trial
Correlation between cerebral oxygen saturation measured by near-infrared spectroscopy and jugular oxygen saturation in patients with severe closed head injury.
Near-infrared spectroscopy has been used to monitor cerebral oxygen saturation during cerebral circulatory arrest and carotid clamping. However, its utility has not been demonstrated in more complex situations, such as in patients with head injuries. The authors tested this method during conditions that may alter the arteriovenous partition of cerebral blood in different ways. ⋯ Cerebral oxygen saturation assessed by near-infrared spectroscopy does not adequately reflect changes in jugular venous oxygen saturation in patients with severe head injury. Changes in arteriovenous partitioning, infrared-spectroscopy contamination by extracerebral signal, algorithm errors, and dissimilar tissue sampling may explain these findings.