International journal of obstetric anesthesia
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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
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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Int J Obstet Anesth · Jul 2007
Epidural analgesia for parturients with type 1 von Willebrand disease.
Epidural analgesia is usually contraindicated in von Willebrand disease. However, in type 1, the increased synthesis of von Willebrand factor (vWF) and factor VIII (FVIII:C) during pregnancy can lead to a correction of biological abnormalities and may allow epidural analgesia to be performed for delivery. ⋯ vWF and FVIII:C increased to normal values in all cases at term in these parturients with type 1 von Willebrand disease. Epidural analgesia, when performed for labor, was uncomplicated. However, platelet aggregation tests with PFA-100 unmasked unexpected, persistent abnormalities. The value of this test for clinical decision making remains to be determined by further prospective studies.
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Int J Obstet Anesth · Jul 2007
Case ReportsCombined spinal-epidural analgesia for labor in a patient with Marfan's syndrome.
We report the management of a patient with Marfan's syndrome for labor analgesia and vaginal delivery using a combined spinal-epidural technique. The rapid onset of analgesia for the first stage of labor provided by the intrathecal opioid, combined with the slow and controlled onset of sensory anesthesia and sympathetic block provided by the dilute epidural local anesthetic, may make this technique particularly useful for labor and delivery in patients with Marfan's syndrome.