International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2005
ReviewIntraoperative nausea and vomiting during cesarean section under regional anesthesia.
Nausea and vomiting during regional anesthesia for cesarean section are very common and unpleasant events. They cause significant distress to the patient and also interfere with the surgical procedure. They have multiple etiologies, which include hypotension, vagal hyperactivity, visceral pain, i.v. opioid supplementation, uterotonic agents and motion. ⋯ Intraoperative nausea and vomiting can be best prevented by controlling hypotension, optimizing the use of neuraxial and i.v. opioids, improving the quality of block, minimizing surgical stimuli and judicious administration of uterotonic agents. Although prophylactic antiemetics have been advocated during cesarean sections, strict adherence to these practices can effectively lower the incidence of intraoperative nausea and vomiting without the requirement of antiemetic agents. Antiemetics, therefore, should be reserved for the prevention of intraoperative nausea and vomiting in high-risk patients and for the treatment of nausea and vomiting not responding to routine measures.
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Int J Obstet Anesth · Jul 2005
Case ReportsSpontaneous acute thoracic epidural hematoma causing paraplegia in a patient with severe preeclampsia in early labor.
This is a case of acute spontaneous thoracic epidural hematoma in a laboring patient at term who presented with severe preeclampsia and acute spinal cord compression, paraplegia, and sensory loss below T8. In early labor, at home, the patient experienced sudden lumbar back pain that progressed to mid-scapular pain leading to paraplegia and T8 sensory loss within one hour of onset of pain. Her symptoms were caused by a spontaneous thoracic epidural hematoma. ⋯ Following cesarean section under general anesthesia, thoracic laminectomy was performed and an epidural hematoma compressing the spinal cord to 2-3 mm was evacuated 13 h after the onset of symptoms. After approximately three months of paraplegia, five months with quad-walker and cane use, the patient can now walk with a cane or other minimal support but has remaining bowel and bladder problems. The conflicting anesthetic management objectives of severe preeclampsia and acute paraplegia secondary to spinal epidural hematoma required compromise in the management of her preeclampsia in order to preserve spinal cord perfusion.
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Int J Obstet Anesth · Jul 2005
Predicting prolonged fetal heart rate deceleration following intrathecal fentanyl/bupivacaine.
Intrathecal opioids for labor analgesia are occasionally associated with fetal heart rate abnormalities. We wanted to identify risk factors for this occurrence. ⋯ This case-control study suggests that if the fetal head is not engaged or if the fetus is experiencing variable decelerations, there is an increased risk of prolonged fetal heart rate deceleration following intrathecal fentanyl/bupivacaine. This finding must now be confirmed in a cohort study.
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Int J Obstet Anesth · Jul 2005
Randomized Controlled Trial Clinical Trial"Ultra-light" patient-controlled epidural analgesia during labor: effects of varying regimens on analgesia and physician workload.
Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for maintenance of labor analgesia. Some of these benefits may depend on the PCEA settings. This study evaluated several regimens for "ultra-light" (0.125%) PCEA with basal continuous infusion (CI) in labor with goals of minimizing physician interventions while providing good analgesia. ⋯ These ultra-light PCEA regimens provided excellent analgesia with minimal physician workload and a high spontaneous delivery rate. Use of moderate to high-volume, ultra-light PCEA/CI techniques should facilitate provision of labor analgesia in busy obstetric units.
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Int J Obstet Anesth · Jul 2005
Case ReportsEpidural abscess in an obstetric patient with patient-controlled epidural analgesia--a case report.
We present the case of a 37-year-old pregnant woman who underwent a cesarean section due to previous cesarean delivery. Spinal anesthesia was performed at the L2-3 intervertebral space with an epidural catheter inserted at L1-2 for postoperative patient-controlled epidural analgesia. When the epidural catheter was removed on day three, an area of redness round the entry point was noted and the patient complained of low back pain, but was discharged from hospital. ⋯ Urgent magnetic resonance imaging revealed an epidural abscess at L1-2. After five days of unsuccessful treatment with oxacillin, a 28-day course of vancomycin, followed by two months of oral fusidic acid, resulted in complete remission of the epidural abscess. The patient has remained free of neurologic deficit.