International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1994
Combined spinal epidural (CSE) analgesia: technique, management, and outcome of 300 mothers.
Epidural analgesia in labour is commonly associated with some degree of lower limb weakness often severe enough to be described as paralysis by the mother. We aimed to produce rapid reliable analgesia with no motor block throughout labour. We report a pilot survey of 300 consecutive women requesting regional analgesia in labour who received a combined spinal epidural blockade (CSE). ⋯ Transient hypotension occurred in 24 women (8%) and was treated with 6 mg intravenous boluses of ephedrine. Complete satisfaction with analgesia and mobility was reported 12-24 h post partum by 95% of mothers. The use of this analgesic technique caused no alteration in obstetric management or post partum care of the women.
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Int J Obstet Anesth · Apr 1994
Pregnancy and cirrhosis: management of hematemesis by Warren shunt during third trimester gestation.
Considerable pathophysiologic changes accompany cirrhosis. Elevation of portal venous pressure predisposes to esophageal varices and hematemesis. ⋯ The anesthetic management of a pregnant cirrhotic patient for a Warren shunt is complicated by concerns for pre-existing hepatic dysfunction and pregnancy-induced physiologic changes as well as fetal well-being. The management of such a case is reviewed and relevant pathophysiology discussed.
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Int J Obstet Anesth · Apr 1994
Awake fibre optic intubation in a 38-week pregnant patient with submandibular abscess.
A 38-week pregnant patient with trismus required surgery for drainage of a submandibular abscess. Her anaesthetic management involved an awake fibre optic intubation. We describe below the details of this and discuss the options for management of similar patients.
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Int J Obstet Anesth · Apr 1994
The morphine sparing effect of diclofenac sodium following caesarean section under spinal anaesthesia.
We have studied the morphine sparing effect of a single 100 mg diclofenac sodium suppository following elective caesarean section performed under spinal anaesthesia. Fifty patients randomly allocated into a placebo or an active group were compared. There was a statistically significant (P < 0.05) reduction in total morphine consumption and in consumption calculated as mg kg h(-1) in the diclofenac group, although pain scores were comparable in the two groups.
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The experiences of 890 parturients were studied across Finland during one week to determine how they experienced labour pain and how effective they regarded the means to alleviate it. The majority of women (72%) had been afraid of labour and 88% had intended to request some pharmacological pain relief. 84% of primiparous and 72% of multiparous rated their pain severe or unbearable. Epidural analgesia was found to be the most effective method in the first stage of labour, but in the second this superiority was no longer apparent. Unfortunately, it seems to be readily available only during office hours in spite of the fact that the majority of deliveries happen outside of that time.