International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2007
Randomized Controlled Trial Comparative StudyA randomised comparison of a hand-held Neurotip and the Neuropen for assessing loss of touch sensation during spinal anaesthesia for caesarean section.
With spinal anaesthesia various methods may be used to assess the block to touch. We wished to compare the levels of block assessed using a non-standardised, assessor-dependent touch stimulus with those assessed when the same stimulus was applied in a standardised manner independent of the assessor. ⋯ When comparing two very similar touch stimuli, one standardised and user-independent and one non-standardised, we observed occasional wide but short lived differences in the assessed levels of block to touch. Although these differences did not affect clinical management, whether more dissimilar touch testing methods might affect clinical management remains to be seen.
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Intrathecal anaesthesia, either as a single shot-spinal or as part of a combined spinal-epidural technique, is now widely accepted as the management of choice for caesarean section. It generally produces rapid and predictable anaesthesia, yet occasionally fails for no apparent reason. Four case reports of seemingly inexplicable complete failure of intrathecal anaesthesia are presented, together with a literature review of other cases and possible causes of the failure, which include anatomical abnormality, drug failure and management failure.
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Int J Obstet Anesth · Jul 2007
ReviewBlood conservation techniques in obstetrics: a UK perspective.
In the UK, maternal mortality due to haemorrhage appears to be rising, with obstetric haemorrhage accounting for 3-4% of the red cells transfused. Allogeneic blood transfusion carries risks such as administration errors, transmitted infections and immunological reactions. The supply of blood is decreasing, partly due to the exclusion of donors who have themselves received a blood transfusion since 1980, in order to stop transmission of variant-Creutzfeldt-Jakob disease. ⋯ Acute normovolaemic haemodilution may induce anaemia and cardiac failure and cannot be used in an emergency. It may have a limited role in combination with other techniques. Intra-operative cell salvage is more effective and useful in obstetrics than the other techniques, overcomes their shortcomings and is endorsed by CEMACH, OAA/AAGBI Guidelines, the National Blood Service and NICE.
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Int J Obstet Anesth · Jul 2007
Randomized Controlled TrialEfficacy of patient-controlled epidural analgesia after initiation with epidural or combined spinal-epidural analgesia.
The aim of the present study was to compare the efficacy of patient-controlled epidural analgesia after initiation with either epidural or combined spinal-epidural analgesia. ⋯ Both regional analgesia techniques followed by demand-only PCEA provided efficient pain relief for labor without changing the duration of labor or rate of cesarean section.
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Int J Obstet Anesth · Jul 2007
Case ReportsVentricular bigeminy during phenylephrine infusion used to maintain normotension during caesarean section under spinal anaesthesia.
A 31-year-old primiparous, healthy woman presented for emergency caesarean section. Following the siting of a spinal anaesthetic, seconds after starting a phenylephrine infusion, she developed ventricular bigeminy. ⋯ The possible proarrhythmic and antiarrhythmic effects of phenylephrine are discussed. We suggest that this was most probably a stretch-induced ventricular arrhythmia due to increased ventricular afterload.