International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2010
Randomized Controlled TrialSide effects of the addition of clonidine 75 microg or sufentanil 5 microg to 0.2% ropivacaine for labour epidural analgesia.
Sufentanil 5 microg and clonidine 75 microg produce a similar reduction in minimum local anaesthetic concentration of ropivacaine. The aim of the present study was to compare the side effects of two equianalgesic solutions by combining 0.2% ropivacaine with either sufentanil 5 microg or clonidine 75 microg for labour epidural analgesia. ⋯ Hypotension occurs more frequently when clonidine is added to epidural ropivacaine instead of an equianalgesic dose of sufentanil. Therefore, clonidine cannot be recommended for routine administration for labour epidural analgesia.
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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.