International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1998
The use of remifentanil infusion to facilitate epidural catheter placement in a parturient: a case report with pharmacokinetic simulations.
We present a case in which remifentanil infusion was used to provide analgesia during epidural catheter placement in a parturient who was experiencing great difficulty staying motionless because of extremely painful uterine contractions. Remifentanil may provide certain advantages in this setting, including improved analgesia during the procedure, briefer residual maternal and fetal (or newborn) drug effects after the procedure, and greater technical ease of catheter placement because of decreased movement induced by pain. Pharmacokinetic simulation of the dose administered suggests that analgesic effect-site concentrations can be rapidly produced, and that these concentrations decline rapidly to clinically insignificant levels after the infusion.
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Int J Obstet Anesth · Apr 1998
Randomized Controlled Trial Clinical TrialMaternal, fetal and placental distribution of lidocaine-epinephrine and bupivacaine after epidural administration for cesarean section.
Bupivacaine and lidocaine are both lipophilic drugs, bupivacaine being more lipophilic and protein-bound. Our earlier studies, using human placenta perfused in vitro, showed that increased placental binding of bupivacaine restricts fetal transfer compared to the higher fetal transfer of lidocaine. However, placental tissue concentrations of local anesthetics have not been determined in the clinical context. ⋯ Values for area under the concentration-time curves per unit of dose were similar. In conclusion, maternal plasma concentrations, fetal/maternal concentration ratios and placental tissue binding of lidocaine resembled those of bupivacaine after epidural administration. These findings are probably explainable by the effect of maternal hypotension on the distribution of lidocaine.
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Int J Obstet Anesth · Apr 1998
Maternal temperature during labour using low-dose (ambulatory) epidural analgesia with bupivacaine and fentanyl.
Maternal temperature is known to increase during labour with conventional epidural analgesia mixtures. To date, the effect of newer low-dose (ambulatory) epidural concentrations on maternal temperature has not been studied. Twenty-six women in established labour received epidural analgesia with 0.1% bupivacaine and 2 microg/ml fentanyl. ⋯ There was no significant overall rise in maternal temperature during labour with the use of an ambulatory epidural mixture. One patient exhibited an increase in temperature of 0.8 degrees C to 38 degrees C after 720 min and another of 1.1 degrees C to 38.1 degrees C after 630 min. We conclude that, whilst overall maternal temperature does not increase following low-dose epidural analgesia, individual increases may still occur after 10 h.
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Int J Obstet Anesth · Apr 1998
Continuous caudal analgesia in labour for a patient with Harrington rods.
We report the case of a 29-year-old patient who had Harrington rods inserted from T8 to L4 at the age of 14. She had been discouraged from having epidural anaesthesia in the antenatal clinic but, whilst in labour, requested analgesia in addition to Entonox and pethidine. Continuous caudal analgesia was commenced and provided good pain relief for labour and delivery.