International journal of obstetric anesthesia
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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
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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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.