International journal of obstetric anesthesia
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Int J Obstet Anesth · Feb 2015
Randomized Controlled TrialThe effect of bupivacaine with fentanyl temperature on initiation and maintenance of labor epidural analgesia: a randomized controlled study.
Labor epidural analgesia is highly effective, but can be limited by slow onset and incomplete blockade. The administration of warmed, compared to room temperature, bupivacaine has resulted in more rapid onset epidural anesthesia. We hypothesized that the administration of bupivacaine with fentanyl at 37°C versus 20°C would result in improved initial and ongoing labor epidural analgesia. ⋯ The administration of epidural 0.125% bupivacaine with fentanyl 2μg/mL at 37°C versus 20°C resulted in more rapid onset and improved labor analgesia for the first 15 min. There was no evidence of improved ongoing labor analgesia or differences in side effects between groups.
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Int J Obstet Anesth · Feb 2015
Observational StudyThe effect of intra-abdominal pressure on sensory block level of single-shot spinal anesthesia for cesarean section: an observational study.
Increased intra-abdominal pressure in pregnancy is thought to affect intrathecal drug spread. However this assumption remains largely untested. The aim of this prospective study was to evaluate the association between intra-abdominal pressure and maximum sensory block level in parturients receiving spinal anesthesia for cesarean section. ⋯ In parturients, intra-abdominal pressure was not associated with spinal block spread, block onset time, recovery or side effects.
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Int J Obstet Anesth · Feb 2015
Case ReportsIntracranial pressure monitoring and caesarean section in a patient with von Hippel-Lindau disease and symptomatic cerebellar haemangioblastomas.
Von Hippel-Lindau disease is a rare genetic disorder which gives rise to a range of tumours including central nervous system haemangioblastomas. We report a case of caesarean section in a patient with symptomatic cerebellar haemangioblastomas associated with von Hippel-Lindau disease. An intracranial pressure monitor was inserted before surgery, which enabled intracranial pressure to be monitored throughout. The anaesthetic implications of von Hippel-Lindau disease are discussed and clinical options explored.
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Int J Obstet Anesth · Feb 2015
Anesthetic management of parturients with pre-existing paraplegia or tetraplegia: a case series.
With improvements in management and rehabilitation, more women with spinal cord injury are conceiving children. Physiologic manifestations of spinal cord injury can complicate anesthetic management during labor and delivery. Patients who delivered at Mayo Clinic, Rochester, Minnesota between January 1, 2001 and May 31, 2012 with a history of traumatic spinal cord injury were identified via electronic record search of all parturients. ⋯ These symptoms were not reported by any patient without a history of autonomic hyperreflexia. Neuraxial labor analgesia may have a higher failure rate in patients with spinal cord injury, possibly related to the presence of Harrington rods. Postpartum exacerbations of autonomic hyperreflexia are common in patients with a history of the disorder.