International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2010
Randomized Controlled TrialA randomised study of magnesium sulphate as an adjuvant to intrathecal bupivacaine in patients with mild preeclampsia undergoing caesarean section.
Adequate analgesia following caesarean section decreases morbidity, hastens ambulation, improves patient outcome and facilitates care of the newborn. Intrathecal magnesium, an NMDA antagonist, has been shown to prolong analgesia without significant side effects in healthy parturients. We therefore studied the effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia in patients with mild preeclampsia undergoing caesarean section. ⋯ In parturients with mild preeclampsia undergoing caesarean delivery, the addition of magnesium sulphate 50 mg to the intrathecal combination of bupivacaine and fentanyl prolongs the duration of analgesia and reduces postoperative analgesic requirements without additional side effects.
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Int J Obstet Anesth · Apr 2010
Case ReportsNeuraxial labor analgesia in an obese parturient with influenza A H1N1.
We describe the use of epidural analgesia in a 39-year-old G2P1 parturient presenting at 38(+6) weeks estimated gestation with confirmed influenza A H1N1 and superimposed bilateral pneumonia. Although the patient had an uncomplicated intra- and post-partum course, little is known about the safety of performing neuraxial analgesia or anesthesia in patients with influenza. The prevalence of viremia and possible translocation of blood-borne virus to the central nervous system are discussed.
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Int J Obstet Anesth · Apr 2010
Case ReportsThe use of fibrinogen concentrate to correct hypofibrinogenaemia rapidly during obstetric haemorrhage.
Haemorrhage is a common complication of childbirth with 0.65% of deliveries associated with significant (>1500 mL) peripartum blood loss. Hypofibrinogenaemia secondary to dilutional and consumptive coagulopathies can be challenging to correct quickly with conventional blood and plasma therapy. Fibrinogen concentrate offers rapid restoration of fibrinogen levels with a small volume infusion and minimal preparation time. ⋯ Six cases of obstetric haemorrhage, associated with hypofibrinogenaemia, treated with fibrinogen concentrate in conjunction with platelets, fresh frozen plasma, packed red blood cells, uterotonics and obstetric intervention are described. In all cases, laboratory assessed coagulation was rapidly normalised and severe haemorrhage improved. These cases suggest that fibrinogen concentrate may be an effective addition to conventional treatments for obstetric haemorrhage associated with hypofibrinogenaemia.
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Int J Obstet Anesth · Apr 2010
Randomized Controlled Trial Comparative StudyA randomized controlled trial using patient-controlled epidural analgesia with 0.25% versus 0.0625% bupivacaine in nulliparous labor: effect on analgesia requirement and maternal satisfaction.
The effect of epidural local anesthetic concentration on analgesic action is still the subject of debate. This study compared the effect of a four-fold change in concentration of bupivacaine for epidural analgesia in labor. ⋯ Larger volumes of more dilute solutions may result in dose sparing and provide more effective labor analgesia. This study supports the continued trend towards dilute local anesthetic mixtures for labor epidural analgesia.