Anaesthesia and intensive care
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A modification of the traditional method of lumbar sympathetic blockade is described. A semi-prone patient position, combined with vertical X-ray screening, are employed to facilitate determination of the level and angle of needle insertion.
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Anaesth Intensive Care · Feb 1983
Case ReportsThe management of headache following accidental dural puncture in obstetric patients.
The progress and management of fifty-eight obstetric patients who received an accidental dural puncture is described. Headache attributable to dural puncture occurred in 85% of patients managed conservatively. Epidural infusion or repeat epidural bolus injections of saline after delivery reduced the incidence to 65%. ⋯ The pathophysiology and treatment of dural puncture headache is reviewed. Reduction of pressure differential across the dural puncture site is most useful in the first 24-48 hours. Persistent and severe headache occurring after this should be treated with blood patch.
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Anaesth Intensive Care · Nov 1982
A three-year survey of an obstetric epidural service with top-up doses administered by midwives.
A three-year survey following the introduction of an epidural service to a maternity unit is presented. 1,438 epidural blocks were attempted (a rate of 30%). Provision of pain relief was the principal indication. There were no serious complications or sequelae although minor complications or difficulties of insertion were noted in 21%. ⋯ Satisfactory pain relief was achieved in 90% during the first stage of labour and 71% during delivery. Of those who delivered, 47% retained an urge to bear down and spontaneous delivery occurred in 43%. 89% of patients interviewed were fully satisfied with, or considerably helped by, the epidural block. Incremental epidural doses were managed by midwives and it is argued that the midwife is ideally suited to this role providing she is trained and experienced and can call for immediate anaesthetic assistance.