International journal of obstetric anesthesia
-
Int J Obstet Anesth · Jan 2009
Case ReportsAccidental intrathecal sufentanil overdose during combined spinal-epidural analgesia for labor.
A laboring woman was accidentally given 45 microg of sufentanil intrathecally in the course of combined spinal-epidural analgesia. She experienced intense pruritus and transient swallowing difficulty without respiratory depression, but still had incomplete pain relief, with delivery and episiotomy repair requiring additional analgesia. This case highlights the importance of adding local anesthetic to intrathecal opioids to facilitate effective analgesia during the second stage of labor. The contributory systems issues and multiple factors that allowed this error to occur are examined.
-
Int J Obstet Anesth · Jan 2009
Randomized Controlled TrialA double-blind randomized controlled trial of patient-controlled epidural analgesia with or without a background infusion following initial spinal analgesia for labor pain.
Patient-controlled epidural analgesia (PCEA) combined with spinal analgesia is an option for pain relief in labor. However, the effect of a CBI on the analgesic requirements of laboring women is still debated. This double-blind study investigated the effect of CBI with PCEA following spinal analgesia on the local anesthetic requirements of parturients during labor. ⋯ In laboring nulliparous patients provided initial labor analgesia with spinal anesthesia, the use of a continuous background infusion decreases PCEA demand dosing, but not the total hourly amount of ropivacaine and fentanyl used.
-
Int J Obstet Anesth · Jan 2009
Randomized Controlled Trial Comparative StudyA comparison of paracervical block with single-shot spinal for labour analgesia in multiparous women: a randomised controlled trial.
Epidural and spinal analgesia may be contraindicated or unavailable in labour. This randomised controlled study examined the suitability of paracervical block as an alternative method of labour analgesia. ⋯ Paracervical block was less effective than single-shot spinal analgesia. Both methods were associated with a low incidence of fetal bradycardia but maternal side effects were more common with single-shot spinal analgesia.
-
Int J Obstet Anesth · Jan 2009
Multicenter StudyThe impact of a teaching program on obstetric anesthesia practices in Croatia.
Many countries fail to use regional techniques for either labor analgesia or obstetric anesthesia. Kybele, an international outreach group, seeks to improve obstetric anesthesia practices worldwide. Its educational program in Croatia was evaluated by studying the change in use of regional anesthetic techniques in obstetrics after a Kybele visit. ⋯ In Croatia, a two-week educational program in obstetric anesthesia increased the use of regional anesthesia and analgesia for labor and delivery in the year that followed the program. Multiple factors limit availability of analgesia for childbirth in Croatia.
-
Int J Obstet Anesth · Jan 2009
Randomized Controlled TrialA randomized study of maternal serum cytokine levels following cesarean section under general or neuraxial anesthesia.
Cytokines are significant mediators of the immune response to surgery and also play a role in parturition. The aim of the study was to investigate the impact of the anesthetic technique for cesarean section on plasma levels of cytokines IL-6 and TNF-alpha. ⋯ Under the present study design anesthetic technique did not affect IL-6 or TNF-alpha concentrations in parturients undergoing elective cesarean section. Serum IL-6 levels increased 24 h postoperatively independently of anesthetic technique.