International journal of obstetric anesthesia
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A primigravida at 41+ weeks gestation presented with spontaneous rupture of membranes. Labour was induced and later an emergency caesarean section was performed for failure to progress. The patient suffered a per-operative uterine tear and post-partum haemorrhage and required postoperative ventilatory support in the intensive care unit. ⋯ The differential diagnosis, diagnostic difficulties, investigations and clinical management of this case are all discussed. An examination of existing literature highlights some of the focal neurological abnormalities that present with eclampsia and the possible need for more sophisticated neuroradiological investigations in these cases. Finally, it is emphasized that anaesthetists and intensivists need to be aware of atypical and delayed presentations of eclampsia.
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Int J Obstet Anesth · Oct 1999
Randomized Controlled Trial Clinical TrialComparison of intermittent epidural bolus, continuous epidural infusion and patient controlled-epidural analgesia during labor.
The aim of the study was to compare efficacy and side-effects produced by three techniques of epidural analgesia during labor: intermittent bolus (1B), continuous epidural infusion (CEI) and patient-controlled epidural analgesia (PCEA). One hundred and fifty parturients allocated randomly to three groups received the same epidural solution of bupivacaine 0.125% with sufentanil 0.5 microg/mL. In the first group (IB: n=50) boluses were administered by the anesthesiologist and titrated to achieve adequate analgesia. ⋯ The other side-effects were equally distributed in the three groups. We concluded that PCEA with bupivacaine and sufentanil is a valuable technique and a good alternative to the IB method. Compared to the CEI technique, PCEA allows a decrease in local anesthetic consumption without impairing the quality of anesthesia.
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Int J Obstet Anesth · Oct 1999
Randomized Controlled Trial Clinical TrialOxford positioning technique improves haemodynamic stability and predictability of block height of spinal anaesthesia for elective caesarean section.
A novel positioning technique was tested to see whether the unpredictability of block height and haemodynamic instability during spinal anaesthesia for caesarean section could be reduced. In this 'Oxford' position, the woman is placed left lateral with an inflated bag under the shoulder and pillows supporting the head. Following spinal injection the woman is turned to an identical right lateral position. ⋯ Block height was more variable in group S than in group O (f test, P = 0.001). Blood pressure decreased by a greater amount initially: group S women required more ephedrine (15.5 +/- 12.9 versus 9.2 +/- 7.7 mg, t test, P = 0.03). Block height with spinal anaesthesia for caesarean section is more predictable and haemodynamically stable if the Oxford position is used whilst anaesthesia develops.
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Int J Obstet Anesth · Oct 1999
Randomized Controlled Trial Clinical TrialComparison of epidural lidocaine and fentanyl to intrathecal sufentanil for analgesia in early labour.
A randomized, double-blind study was undertaken comparing an epidural test dose of lidocaine followed by 100 microg fentanyl (E-LF, n = 19) to combined spinal epidural sufentanil 10 microg (CSE-S, n = 21) in low risk women in early labour. The primary outcome measured was the duration of analgesia; secondary outcomes included the quality of analgesia, incidence and severity of pruritus, lower limb motor blockade, and the ability to ambulate. A P < 0.05 was considered statistically significant. ⋯ The VAS for pruritus were higher in the CSE-S group (P < 0.05) but no patient requested treatment for pruritus. Mild motor weakness was more frequent in the E-LF group (5/19 versus 20/21, P < 0.05) and fewer patients in the E-LF group met criteria for ambulation (13/19 versus 20/21, P < 0.05). While both E-LF and CSE-S provide effective analgesia for women in early labour, the more rapid onset of analgesia, lower VAS pain scores, longer duration of action and lesser impact on ability to ambulate suggest advantages of CSE-S over E-LF.