International journal of obstetric anesthesia
-
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.
-
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.
-
Int J Obstet Anesth · Jul 2007
Case ReportsAspergillus meningitis following spinal anaesthesia for caesarean section in Colombo, Sri Lanka.
We report six cases of Aspergillus meningitis after spinal anaesthesia for caesarean section administered in June and July 2005. Three patients died before a fungal infection was confirmed at the first post-mortem examination in August. ⋯ Some syringes and spinal needles supplied to the hospitals concerned were found to be contaminated with Aspergillus fumigatus. Investigators found that medical supply storage facilities were substandard following the influx of donations after the tsunami of December 2004.
-
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.
-
Int J Obstet Anesth · Jul 2007
Case ReportsRapid reversal of critical haemodynamic compromise with nitric oxide in a parturient with amniotic fluid embolism.
We describe a case of amniotic fluid embolism presenting as cardiovascular collapse during labour. After initial resuscitation and emergency caesarean section, the patient was transferred to the intensive care unit with profound hypoxaemia, a high inotropic drug requirement and severe coagulopathy. ⋯ The introduction of nitric oxide at 40 ppm produced a dramatic improvement in her cardiorespiratory status. Mother and baby both survived with no apparent long term sequelae.