International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2004
Comparative Study Clinical TrialDoes pregnancy increase the efficacy of lumbar epidural anesthesia?
Pregnancy has been reported to enhance the sensitivity of nerves to local anesthetics and to decrease anesthetic requirements during regional anesthesia. In this study, whether pregnancy increased the efficacy of lumbar epidural anesthesia was evaluated. Two populations (14 pregnant and 14 non-pregnant women) undergoing lumbar epidural anesthesia were studied and received 17 mL of 2% lidocaine-epinephrine (1: 200,000). ⋯ In pregnant women, cephalad spread of epidural anesthesia was facilitated but latency of blockade, density and motor blockade were not. It takes over 25 min to achieve satisfactory blockade at sacral segments. Those who perform lumbar epidural anesthesia alone for cesarean section should consider the use of additives (e.g. fentanyl, bicarbonate) to enhance the block, or a greater volume of local anesthetic.
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Int J Obstet Anesth · Apr 2004
Case ReportsIs continuous spinal analgesia via an epidural catheter appropriate after accidental subarachnoid administration of 15 mL of bupivacaine 0.1% containing fentanyl 2 micrograms/mL?
We report a case of accidental insertion of an epidural catheter into the subarachnoid space and accidental administration of 15 mL of bupivacaine 0.1% with fentanyl 2 micrograms/mL, in the sitting position, during labour. Within 5 min, the patient was unable to move her lower limbs. Although the upper level of the sensory block using ethyl chloride was found to be T5, there was no cardiovascular depression. ⋯ This was conducted under spinal anaesthesia using 2 mL of hyperbaric bupivacaine 0.5% with fentanyl 20 micrograms. A healthy baby was delivered with Apgar scores of 10 and 10, at 1 and 5 min, respectively. There was no postdural puncture headache or any neurological complications.
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Int J Obstet Anesth · Apr 2004
Case ReportsAnaesthesia for caesarean section in a patient with syringomyelia and Arnold-Chiari type I malformation.
A 37-year-old primiparous woman with syringomyelia and Arnold-Chiari type I malformation was scheduled to undergo elective caesarean section for a fetus in the breech presentation. Caesarean section was performed under general anaesthesia without complications; all we observed was an exaggerated response to atracurium. ⋯ Syringomyelia is a progressive myelopathy characterised by cystic degeneration within the spinal cord, which causes severe neurological deficits. The anaesthetic management is discussed.
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Int J Obstet Anesth · Apr 2004
Case ReportsVery low-dose spinal anesthesia for cesarean section in a morbidly obese preeclamptic patient and its potential implications.
To our knowledge, based on a literature search, this is the first case report of successful cesarean section requiring a very low total dose of 5 mg hyperbaric spinal bupivacaine without any spinal or intravenous supplements in a morbidly obese (BMI=66 kg/m(2)) preeclamptic parturient. This parturient appeared to be more sensitive than the average to spinal anesthesia for cesarean section. ⋯ This report does not suggest the routine use of low-dose spinal anesthesia without supplements, but illustrates the wide variability in dosage and sensitivity to spinal anesthetics, and suggests that further research is needed in this area, particularly in morbidly obese parturients. Furthermore, it emphasizes the importance of vigilance and frequent blood pressure and respiration monitoring even in cases of low-dose spinal analgesia, such as that used in the combined spinal-epidural technique for labor analgesia.