International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 1996
Anaesthetic management of labour in two patients with Klippel-Feil syndrome.
Two patients with Type I Klippel-Feil syndrome presented at the antenatal clinic. The first patient, who suffered from sleep apnoea, was delivered of a healthy infant by vacuum extraction. ⋯ In both cases epidural analgesia was employed to allow pain relief during labour. Anaesthetic management of Klippel-Feil syndrome is discussed and the benefits of early anaesthetic assessment and continued involvement of senior anaesthetic and obstetric staff emphasized.
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Int J Obstet Anesth · Jul 1996
Information and concerns about obstetric anesthesia: a survey of 320 obstetric patients.
This study was undertaken to assess women's knowledge and concerns about obstetric anesthesia and to determine if they perceive a need for an anesthesia interview before the onset of labor. A 17 item questionnaire was distributed to 407 women on postpartum day one. The women were questioned about their knowledge, anxiety and concerns regarding obstetric anesthesia. ⋯ The majority (59%) of the women would have wanted a preoperative visit with an anesthesiologist before labor. These results illustrate that most women are anxious about obstetric anesthesia and do not feel adequately prepared. Efforts at educating women about obstetric anesthesia would be welcomed by them and methods to accomplish this goal are discussed.
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Int J Obstet Anesth · Jul 1996
alpha1-acid glycoprotein and albumin in the spinal fluid of pregnant women.
Pregnant women at term need a smaller dose of local anaesthetic to produce the same spinal anaesthesia as non-pregnant women. The aim of the study was to see whether the concentrations of binding proteins were reduced in spinal fluid in pregnant women. The concentrations of the binding proteins [Formula: see text] glycoprotein (AAG) and albumin were measured in plasma and spinal fluid from 20 pregnant and 20 non-pregnant women, ASA 1. ⋯ The concentrations in plasma were also reduced in late pregnancy. All the changes were statistically significant. Since only a minor fraction of bupivacaine seems to be protein bound in spinal fluid these differences may have only a little influence on the free fraction and cannot be solely responsible for the increased sensitivity of pregnant women to spinal anaesthesia.
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Int J Obstet Anesth · Jul 1996
Analgesic efficacy of intravenous morphine in labour pain: a reappraisal.
The aim of the present study was to investigate the dose-related analgesic effect of intravenous (i.v.) morphine during spontaneous term first stage labour. This was an open study in 17 parturients who requested analgesia for severe labour pain. All women were given morphine i.v. in repeated doses of 0.05 mg/kg following every third contraction until a final dose of 0.20 mg/kg was reached. ⋯ No adverse reactions related to morphine were noted in the neonates. We conclude that i.v. morphine does not significantly reduce overall labour pain intensity. Thus, if a real analgesic effect is desired, systemically given morphine seems inappropriate and other techniques should be used.
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Int J Obstet Anesth · Jul 1996
A comparison of non-invasive methods of blood pressure measurement in normotensive and hypertensive pregnant women.
We compared two types of automatic non-invasive blood pressure measuring device with sphygmomanometey in 47 normotensive and 38 hypertensive women in the third trimester of pregnancy. An automatic oscillometric device (Accutor) and a volume-clamp device (Finapres) significantly underestimated the diastolic pressure as measured by the fourth Korotkoff sound using a Hawksley random zero sphygmomanometer. ⋯ The mean difference between the sphygmomanometer and Finapres measurement of diastolic blood pressure was +6.1 mmHg in the normotensive women and +11.5 mmHg in hypertensive women (P = 0.003). The increased use of continuous non-invasive devices to monitor blood pressure in women with hypertension should be accompanied by sound knowledge of their limitations in this group of patients.