International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2003
Continuous spinal analgesia for labor pain in a parturient with aortic stenosis.
Aortic stenosis in pregnancy carries a high fetal and maternal morbidity and mortality. Spinal analgesia/anesthesia is considered by many to be contraindicated in these patients. The rapid onset of sympathetic block induces hypotension, which can result in myocardial hypoperfusion and myocardial ischemia. ⋯ Pure intrathecal opioid analgesia was used initially to maintain hemodynamic stability. However after two bolus administrations of sufentanil, analgesia was further maintained using ropivacaine and sufentanil. A spinal catheter was chosen to provide reliable anesthesia, which could be extended rapidly for cesarean section.
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Int J Obstet Anesth · Jan 2003
Comparison of continuous infusion versus midwife administered top-ups of epidural bupivacaine for labour analgesia: effect on second stage of labour and mode of delivery.
Using a population-based study we retrospectively compared the effect of continuous versus intermittent top-up epidural analgesia on the outcome of labour at the University Hospital of Wales. We analysed the labour outcome of 410 primigravid deliveries over an 18-month period during a change in delivery suite protocol. ⋯ There were no significant differences in terms of group characteristics, women undergoing assisted vaginal delivery (group 1: 83 vs. group 2: 70, OR 0.8 CI 0.5-1.2), caesarean section (group 1: 59 vs. group 2: 61, OR 1.0 CI 0.6-1.5), and women with prolonged second stage (group 1: 50 vs. group 2: 47, OR 1.1 CI 0.6-1.8). The presumed reduction in motor blockade associated with intermittent top-up epidural regimes did not affect the outcome of labour.
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Int J Obstet Anesth · Jan 2003
Comparison of general and epidural anesthesia in elective cesarean section for placenta previa totalis: maternal hemodynamics, blood loss and neonatal outcome.
There are few consistent guidelines in choosing anesthesia for cesarean section for a parturient with placenta previa. This prospective randomized trial was organized to compare the maternal hemodynamics, blood loss and neonatal outcome of general versus epidural anesthesia for cesarean section with the diagnosis of grade 4 placenta previa. After giving informed consent, 12 patients received general anesthesia and 13 received epidural. ⋯ The Apgar scores at 1 and 5 min were similar in the two groups (8 [4-9] vs. 8 [7-9] and 10 [6-10] vs. 9 [9-10], respectively). We concluded that epidural anesthesia is superior to general anesthesia in elective cesarean section for grade 4 placenta previa with regard to maternal hemodynamics and blood loss. There was no difference in neonatal outcome.