International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1999
Randomized Controlled Trial Clinical TrialPain during elective caesarean section under epidural anaesthesia: the effect of a 10 degrees head-up tilt position.
One hundred patients scheduled for elective caesarean section under epidural anaesthesia were randomized to have epidural loading doses in either the horizontal or a 10 degrees head-up position. They were assigned to their position only after an initial dose of 4 ml of 0.5% bupivacaine had been given. Ten minutes after this dose they were given 10 ml of 0.5% bupivacaine and 50 microg of fentanyl in their allocated position. ⋯ The inter-quartile range was 0 to 2 for the head-up tilt position and 0 to 4 for the horizontal position (P<0.05). Position had no significant effect on the blood pressure or Bromage score. A 10 degrees head-up tilt position is useful during the establishment of epidural anaesthesia to reduce the pain experienced by the patient during caesarean section.
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A retrospective audit of obstetric epidurals was performed at Royal Surrey County Hospital. The aim was to determine the efficacy of epidural blood patch in the management of post-dural puncture headache following inadvertent dural puncture in the obstetric population, over a 5-year period between March 1993 and February 1998. ⋯ Following treatment with one epidural blood patch, 33% of patients obtained complete and permanent relief, 50% partial relief and 12% no relief. Twenty-nine percent of patients required a second epidural blood patch of which 50% were completely successful, 36% were partially successful and 14% gave no relief.
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Angioneurotic oedema is a rare disease caused by Cl esterase inhibitor deficiency. Hereditary angioneurotic oedema includes type I (quantitative and functional) deficiency and type 11 (functional) deficiency. Its prophylactic treatment during pregnancy, based on danazol therapy if the fetus is male, may avoid acute attacks of generalized or laryngeal oedema. ⋯ Regional analgesia is indicated for labour or caesarean section to prevent pain and stress and to avoid the difficulties associated with laryngeal oedema and tracheal intubation. In the treatment of an acute attack, Cl esterase inhibitor concentrates (1500 units) may be given i.v. We present two cases, one of hereditary and one of acquired angioneurotic oedema, both presenting during pregnancy and both delivered vaginally under epidural analgesia with successful outcome.
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Preeclampsia/eclampsia affects only a small proportion of all pregnancies, yet accounts for much of the obstetric morbidity and mortality seen in the USA and UK. A full understanding of preeclampsia/eclampsia, its variable presentation and complex pathophysiology allows the consulting anesthesiologist to optimize a plan for anesthetic management of the afflicted patient.