International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2009
Randomized Controlled Trial Comparative StudySingle-shot spinal anaesthesia, combined spinal-epidural and epidural volume extension for elective caesarean section: a randomized comparison.
Single-shot spinal and combined spinal-epidural block, with or without epidural volume extension, can be used for caesarean section. There is no trial comparing their block characteristics and adverse effects under identical conditions. ⋯ Intrathecal block is similar in extent and duration whether given as a single-shot spinal or a combined spinal-epidural with or without epidural volume extension when performed for elective caesarean section using hyperbaric bupivacaine in the sitting position.
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Int J Obstet Anesth · Jul 2009
Multicenter StudyA national survey of obstetric early warning systems in the United Kingdom.
Despite recommendations in the two most recent Confidential Enquiries into Maternal and Child Health (CEMACH) reports, and improvements in patient care using early warning scoring systems (EWS) in the general adult population, no validated system currently exists for the obstetric population. ⋯ The survey results support CEMACH recommendations for a nationally agreed obstetric EWS.
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Int J Obstet Anesth · Jul 2009
Multicenter StudyThe preparation and storage of anaesthetic drugs for obstetric emergencies: a survey of UK practice.
Traditionally anaesthetic drugs for obstetrics are prepared as a contingency and stored until they are required for emergency use or have expired. Expiry is based on presumed reduction in sterility and efficacy although evidence for this is inconsistent. Preparation in advance introduces the risk of error and potential for tampering by a third party. Discarding and re-preparing drugs daily represents significant wastage with associated cost implications. We predicted that practice of drug preparation would differ widely across the UK, so conducted a national survey. ⋯ The majority of UK obstetric units routinely draw up emergency drugs every 24h. With conflicting evidence regarding sterility and efficacy this represents tremendous wastage and potential for drug error and tampering. We propose that nationwide introduction of commercially- and pharmacy-prepared drugs with long shelf lives would improve safety and cost effectiveness.
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Int J Obstet Anesth · Jul 2009
An observational cohort study of the meniscus test to detect intravascular epidural catheters in pregnant women.
The meniscus test is a rapid non-pharmacologic method of confirming epidural catheter placement by observing a normal saline meniscus while physically manipulating the catheter. The aim of this study was to assess whether the meniscus test improves diagnostic accuracy of aspiration to detect intravascular or intrathecal placement of epidural catheters in pregnant women. ⋯ For obstetric patients in the sitting position, the meniscus test does not improve diagnostic accuracy of aspiration for detecting intravascular multiorifice epidural catheter placement.
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Int J Obstet Anesth · Jul 2009
Case ReportsCesarean section and primary pulmonary hypertension: the role of intravenous dexmedetomidine.
Primary pulmonary hypertension is a fatal disease that frequently becomes evident in pregnancy. The management of pregnant women with primary pulmonary hypertension poses a number of difficult problems, especially where regional anesthesia is considered to be contraindicated. A 30-year-old woman who developed primary pulmonary hypertension at 23 weeks of pregnancy was transferred to our hospital. ⋯ Intravenous dexmedetomidine was specifically used during emergence and recovery from anesthesia. This provided effective pain relief and hemodynamic stability. Throughout the clinical course, brain natriuretic peptide levels was monitored and used as an indicator of cardiac failure.