International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2014
The incidence and management of inability to advance Arrow FlexTip Plus® epidural catheters in obstetric patients.
Difficulty advancing epidural catheters is troublesome to obstetric anesthesiologists. Flexible epidural catheters have been shown to reduce paresthesiae and intravascular catheter placement in parturients, but the cause of inability to advance these catheters past the epidural needle tip remains undefined. Specifically, its incidence and effective management strategies have not been described. ⋯ Inability to advance Arrow FlexTip Plus® epidural catheters was relatively common (4.5%) and occurred despite confidence in obtaining loss of resistance. Injecting saline may be corrective and appears to have little disadvantage. However, removing the needle and performing a new placement was the most successful corrective maneuver.
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Int J Obstet Anesth · May 2014
Randomized Controlled Trial Comparative StudyA randomized, observer-blind comparison between the Neurotip mounted Neuropen and a disposable plastic neurological wheel for assessing the level of spinal blockade at cesarean section.
Various methods are used to assess the height of sensory block to touch under spinal anesthesia for cesarean section. We tested a novel, inexpensive, miniature, user-dependent plastic neurological wheel against the user-independent Neurotip mounted Neuropen. ⋯ The compact plastic neurological wheel is as clinically reliable as the Neurotip mounted Neuropen.
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Int J Obstet Anesth · May 2014
Randomized Controlled TrialThe effect of intravenous ondansetron on maternal haemodynamics during elective caesarean delivery under spinal anaesthesia: a double-blind, randomised, placebo-controlled trial.
Spinal anaesthesia for caesarean delivery is frequently associated with adverse effects such as maternal hypotension and bradycardia. Prophylactic administration of ondansetron has been reported to provide a protective effect. We studied the effect of different doses of ondansetron in obstetric patients. ⋯ In our study, prophylactic ondansetron had little effect on the incidence of hypotension in healthy parturients undergoing spinal anaesthesia with bupivacaine and fentanyl for elective caesarean delivery.
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In the UK earlier discharge of patients following elective caesarean section would require that more patients are discharged the day after surgery. The introduction of enhanced recovery in other specialties has resulted in shorter postoperative stay. We surveyed current U.K. practice to find whether this was consistent with enhanced recovery and what changes units would need to introduce to establish such a programme. ⋯ Most obstetric units support the concept of enhanced recovery following caesarean section and many could introduce a programme for elective surgery with relatively small changes in patient care.