International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2009
Clinical TrialThe effects of meperidine and epidural analgesia in labor on maternal heart rate variability.
Epidural and parenteral opioid analgesia are two common methods of pain relief in labor that may influence the autonomic nervous system. However, these effects on laboring women have not yet been adequately studied. The aim of our study was to assess the effects of these two methods of analgesia on autonomic nervous system modulation of maternal heart rate variability in laboring women. ⋯ Meperidine caused an autonomic nervous system shift towards sympathetic activation with abolition of respiratory sinus arrhythmia high-frequency spectral band. Conversely epidural analgesia had no significant effect on autonomic nervous system control of heart rate.
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Int J Obstet Anesth · Apr 2009
Randomized Controlled TrialHetastarch co-loading is as effective as pre-loading for the prevention of hypotension following spinal anesthesia for cesarean delivery.
Pre-loading with hetastarch decreases the incidence and severity of hypotension after spinal anesthesia for cesarean delivery. However, pharmacokinetic studies with crystalloid predict that fluid loading should be more efficacious if rapidly administered immediately after induction of spinal anesthesia. The aim of this study was to compare pre- and co-loading of hetastarch for the prevention of hypotension following spinal anesthesia for cesarean delivery. ⋯ Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension after spinal anesthesia for cesarean delivery. Surgery need not be delayed to allow a predetermined pre-load to be administered before induction of spinal anesthesia.
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Int J Obstet Anesth · Apr 2009
Randomized Controlled TrialED95 of phenylephrine to prevent spinal-induced hypotension and/or nausea at elective cesarean delivery.
The purpose of this trial was to determine the 95% effective dose (ED95) of phenylephrine by intermittent i.v. bolus, to prevent spinal-induced hypotension and/or nausea at elective cesarean delivery. ⋯ The ED95 of phenylephrine, administered as intermittent boluses to prevent pre-delivery spinal-induced hypotension and/or nausea at elective cesarean delivery, is at least 122 microg (lower limit of the confidence interval). The safety of this dose warrants further studies.
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Int J Obstet Anesth · Apr 2009
Anaesthesia mode for caesarean section and mortality in very preterm infants: an epidemiologic study in the EPIPAGE cohort.
Little is known about the influence of anaesthesia for caesarean section on outcome in very preterm infants. ⋯ In this population-based study, spinal anaesthesia was associated with an increased risk of neonatal mortality in very preterm infants compared to general anaesthesia (and epidural anaesthesia), independently from gestational age and characteristics of the pregnancies, deliveries and neonates. Although this multivariate analysis does not prove a causal relationship, the results suggest it could exist, particularly if maternal haemodynamics are poorly controlled. With recent significant change in the conduct of spinal anaesthesia, further studies are needed to investigate potential harmful effects of anaesthesia on very preterm infants delivered by caesarean section.
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Int J Obstet Anesth · Apr 2009
Case ReportsAnaesthetic management of parturients with hereditary haemorrhagic telangiectasia for caesarean section.
Hereditary haemorrhagic telangiectasia, also known as Osler-Weber-Rendu disease, is a vascular disorder characterized by multiple mucocutaneous and visceral arteriovenous malformations. There is little in the literature about the anaesthetic management of parturients with this condition. ⋯ The second patient had general anaesthesia because investigations could not rule out neurological involvement. We review and discuss the anaesthetic considerations for obstetric patients with hereditary haemorrhagic telangiectasia.