International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2009
Randomized Controlled Trial Comparative StudyLow-dose epidural top up for emergency caesarean delivery: a randomised comparison of levobupivacaine versus lidocaine/epinephrine/fentanyl.
Levobupivacaine has a greater safety margin for cardiotoxicity than bupivacaine; consequently it has been recommended as the agent of choice for extending low-dose epidural analgesia for emergency caesarean section. We wished to compare the onset of levobupivacaine with that of a 2% lidocaine/epinephrine/fentanyl mixture. ⋯ A freshly prepared mixture of 2% lidocaine 20 mL plus epinephrine 100 mug and fentanyl 100 mug provides a more rapid onset and superior quality T7 block to touch than 0.5% levobupivacaine 20 mL.
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Int J Obstet Anesth · Oct 2009
Randomized Controlled TrialIntra-operative fluid warming in elective caesarean section: a blinded randomised controlled trial.
We assessed the effect of warming intravenous fluids during elective caesarean section under combined spinal-epidural anaesthesia in a blinded, randomised controlled trial. ⋯ Warming intravenous fluids mitigates the decrease in maternal temperature during elective caesarean section under combined spinal-epidural anaesthesia and improves thermal comfort, but does not affect shivering. Intravenous fluids should be warmed routinely in elective caesarean section, especially for cases of expected long duration, but the use of pre-warmed fluids is as efficient and cheaper than using a Hotline fluid warmer.
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Int J Obstet Anesth · Oct 2009
Randomized Controlled Trial Comparative StudyA randomized controlled study of whether the partner's presence in the operating room during neuraxial anesthesia for cesarean delivery reduces patient anxiety.
This study compared anxiety in two groups of women undergoing elective cesarean delivery to ascertain if their partner's presence during neuraxial anesthesia placement affected patients' overall anxiety levels. ⋯ Although patients whose partners were present in the operating room at the time of neuraxial anesthesia placement reported less anxiety over the time of the study than did patients whose partners were not present, these differences were small and are not considered to be clinically important. Increased anxiety among partners who were not present at neuraxial placements warrants further study.
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Int J Obstet Anesth · Oct 2009
Randomized Controlled TrialA randomized controlled trial of the effect of combined spinal-epidural analgesia on the success of external cephalic version for breech presentation.
Improving the success of external cephalic version (ECV) for breech presentation may help avoid some cesarean deliveries. The results of randomized trials comparing the success of ECV with neuraxial analgesia compared to control are inconsistent. We hypothesized that combined spinal-epidural (CSE) analgesia would increase the success of ECV when compared with systemic opioid analgesia. ⋯ There was no difference in the rate of successful ECV or vaginal delivery with CSE compared to intravenous fentanyl analgesia. Pain scores were lower and satisfaction higher with CSE analgesia, and median time to fetal heart rate reactivity was shorter in the CSE group.