International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2005
Randomized Controlled Trial Comparative StudyAutomated regular boluses for epidural analgesia: a comparison with continuous infusion.
Intermittent epidural bolus dosing is a method of drug delivery that can prolong the duration of labour analgesia induced by a combined spinal epidural (CSE). In this randomized, double-blinded study, we compared the analgesic efficacy of two drug delivery systems: regular intermittent epidural boluses and continuous epidural infusion and assessed the incidence of breakthrough pain after CSE. ⋯ Automated regular bolus delivery of epidural analgesia when compared with continuous infusion decreased the incidence of breakthrough pain and increased maternal satisfaction. In a busy obstetric unit, this may also serve to decrease the anesthetists' workload.
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Int J Obstet Anesth · Oct 2005
Randomized Controlled Trial Comparative StudyIs ephedrine infusion more effective at preventing hypotension than traditional prehydration during spinal anaesthesia for caesarean section in African parturients?
Hypotension following spinal anaesthesia for caesarean section may result in maternal nausea and vomiting and decreased uteroplacental blood flow with possible fetal acidaemia. Numerous methods have been tried to minimise hypotension. In developing countries where resources are limited, this study aimed to compare a standard infusion of ephedrine with traditional prehydration to prevent spinal hypotension. ⋯ Prophylactic ephedrine given by standard infusion set was more effective than crystalloid prehydration in the prevention of hypotension during spinal anaesthesia for elective caesarean section.
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Int J Obstet Anesth · Oct 2005
Case ReportsLow-dose sequential combined spinal-epidural: an anaesthetic technique for caesarean section in patients with significant cardiac disease.
In the United Kingdom, cardiac disease is the second most common cause of all maternal deaths. The best anaesthetic technique for caesarean section in these patients has yet to be established. ⋯ Invasive monitoring was used in each case, and drugs with significant cardiovascular effects were avoided or used with extreme caution. Multidisciplinary team involvement, including serial echocardiography in the antenatal period, is strongly recommended.
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We describe the anaesthetic management of a spontaneous vaginal delivery at 39 weeks' gestation in a 22-year-old patient with congenital long QT syndrome. With a strong family history of sudden deaths, the patient had an initial QT interval corrected for rate (QTc) of >600 ms. Following a once-daily 50-mg dose of atenolol over the previous 11 months, her QTc remained prolonged at 560 ms. ⋯ Levobupivacaine was substituted for routine racemic bupivacaine to decrease the risk of drug-induced cardiotoxicity. Delivery outcome was successful and uneventful. We outline the pathophysiology, risks and treatments of long QT syndrome, and discuss the analgesic management of this patient in labour with congenital long QT syndrome.
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Intrathecal morphine can produce hypothermia in animals. This side effect has been reported in humans, but has not been thoroughly studied in obstetrics. ⋯ We conclude that symptomatic hypothermia is an occasional side effect of cesarean section under spinal anesthesia. We believe this syndrome is due to intrathecal morphine. While the duration is limited to 6h, lorazepam appears to treat both hypothermia and symptoms.