International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1997
Randomized Controlled Trial Clinical TrialPatient-controlled analgesia following caesarean section: a comparison of morphine and meptazinol.
Forty-eight women were investigated in a prospective double-blind study and randomised to receive intravenous patient-controlled analgesia (PCA) with meptazinol or morphine following elective caesarean section. Women received PCA boluses of 1 mg morphine or 10 mg meptazinol with no background infusion. ⋯ There was no statistically significant difference in pain scores (P = 0.47) or the incidence of side-effects (nausea/vomiting P = 0.076, sedation P = 0.63) between the two drugs. Meptazinol is more expensive and offers no clinical advantages in this group of patients.
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Int J Obstet Anesth · Apr 1997
Anesthesia for combined cesarean section and extra-adrenal pheochromocytoma resection: a case report and literature review.
Pheochromocytoma during pregnancy is unusual, with approximately 250 cases now reported in the literature. The current case describes the anesthetic management of a patient with a large extra-adrenal pheochromocytoma who underwent a combined cesarean section and tumor removal in which perioperative hemodynamic control was difficult despite high-dose a-adrenergic blockade. ⋯ Established criteria exist for the adequacy of alpha- and beta-adrebergic blockade for the management of pheochromocytoma in the non-pregnant patient. We discuss how these criteria apply to pregnant patients with pheochromocytoma, and suggest possible modifications to the criteria.
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Int J Obstet Anesth · Apr 1997
Anaesthesia and the antiphospholipid syndrome: a review of 20 obstetric patients.
The case notes of 20 obstetric patients with antiphospholipid syndrome delivering over a 4-year period were reviewed retrospectively. There were complete details for 22 singleton pregnancies. Obstetric complications in the pregnancies under review were frequent. ⋯ The estimated blood loss at these deliveries did not exceed 600 ml. Eleven women (55%) had a previous history of thrombosis. Two women had thrombotic episodes during their pregnancies and three had them post partum despite antithrombotic measures.
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Int J Obstet Anesth · Apr 1997
Randomized Controlled Trial Clinical TrialA comparison of catheter vs needle injection of local anesthetic for induction of epidural anesthesia for cesarean section.
It is generally believed that bolus injections of local anesthetic through an epidural needle produce a more rapid onset of blockade, but at the expense of an increased incidence and severity of hypotension, whereas intermittent injections through a catheter take longer to achieve adequate anesthesia but with a lower risk of hypotension. The present study investigated two commonly used needle and catheter epidural injection techniques for differences in speed of onset of surgical anesthesia and incidence and severity of hypotension. ⋯ No significant difference was found for the time to onset of surgical anesthesia. In the absence of benefits of needle injection, incremental catheter administration of local anesthetic with its multiple safety advantages is the technique of choice for induction of epidural anesthesia for cesarean section.
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Int J Obstet Anesth · Apr 1997
Cardiac arrest complicating spinal anaesthesia for caesarean section.
We present a 36-year-old multiparous woman who developed intractable hypotension and cardiac arrest during spinal anaesthesia for elective caesarean section. Cardiopulmonary resuscitation was successful and both mother and baby made a good recovery. Postoperative investigation revealed a dilated cardiomyopathy related to pregnancy. This case highlights the importance of expediting delivery of the neonate during maternal cardiopulmonary resuscitation, the prompt use of adrenaline as inotropic support, and preoperative assessment in apparently healthy parturients.