International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1998
Randomized Controlled Trial Clinical TrialVolume preload: lack of effect in the prevention of spinal-induced hypotension at caesarean section.
A randomized double-blind study of 40 women was performed to compare blood pressure changes between two groups of women following induction of spinal anaesthesia for elective caesarean section. One group received a 1 L Ringer's solution preload, administered over 10 min, before spinal anaesthesia while the other group received no preload. ⋯ There were no differences between the groups in terms of neonatal outcome as assessed by Apgar score, umbilical arterial and venous blood pH, and Neonatal Adaptive Capacity Scores. When ephedrine is infused prophylactically immediately following spinal anaesthesia for elective caesarean section, a 1000 ml crystalloid preload confers no advantages in terms of maternal blood pressure control or neonatal outcome.
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Int J Obstet Anesth · Apr 1998
Randomized Controlled Trial Clinical TrialAnalgesia produced by epidural diamorphine is better following caesarean section under spinal anaesthesia than under epidural anaesthesia.
In a randomized double-blind study, the efficacy, duration of action and side-effects of epidural diamorphine 2.5 mg in 10 ml normal saline were compared following elective caesarean section under either spinal anaesthesia (using a combined spinal epidural technique, n = 32) or conventional epidural anaesthesia (n = 26). Median visual analogue pain scores were consistently lower in patients who had received spinal anaesthesia and this reached significance at 24 h (P = 0.02). ⋯ The incidence of side-effects was similar in the two groups. The improved analgesia following spinal anaesthesia is another advantage of the combined spinal epidural technique over conventional epidural anaesthesia for elective caesarean section.
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This is a retrospective record of the analgesic management during labour of 16 patients with spina bifida seen at Leicester Royal Infirmary Maternity Hospital between March 1994 and February 1996. The information highlights the potential difficulties in providing epidural analgesia for this patient group, and demonstrates how an antenatal pre-anaesthetic clinic can help to optimize pain management by providing the opportunity to formulate a realistic analgesic plan, which can be documented in the notes.
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Int J Obstet Anesth · Apr 1998
Complete recovery after near-fatal venous air embolism during cesarean section.
During replacement to the abdomen of the exteriorized uterus at cesarean section under epidural block, a previously healthy woman developed cardiorespiratory arrest. Tracheal intubation revealed low end-tidal carbon dioxide concentration suggesting embolization. Resuscitative efforts were successful. Uterine exteriorization - as well as the Trendelenburg position - significantly increase the risk of air embolization so that routine use of appropriate monitors is indicated to facilitate early diagnosis.