International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1998
Mivacurium for caesarean section in hypertensive parturients receiving magnesium sulphate therapy.
The interaction between mivacurium and magnesium sulphate was investigated in a group of parturients undergoing caesarean section under general anaesthesia. Thirty parturients were studied; 10 normotensive controls (group NT), 10 hypertensive controls (group HT) and 10 hypertensives who received magnesium sulphate (group HTM). At induction group HT received 30 microg/kg of alfentanil and group HTM 10 microg/kg of alfentanil and 30 or 60 mg/kg of magnesium sulphate. ⋯ Time to maximal recovery, and time from 25-75% of maximal recovery from mivacurium, were significantly prolonged in group HTM (60.9 +/- 15.3 min and 16.8 +/- 5.6 min) compared with group HT (34.9 +/- 7.6 min and 7.6 +/- 3.6 min) and group NT (37.4 +/- 14.4 min and 8.5 +/- 3.4 min) (P < 0.01). Time to 25% recovery was prolonged in group HTM (35.1 +/- 7.4 min) compared with the other two groups (HT: 21.6 +/- 6.4 min and NT: 22.8 +/- 10.2 min) (P < 0.01). Whilst the duration of action of mivacurium, determined by electromyography, is prolonged by subtherapeutic serum magnesium concentrations, of the available non-depolarizing relaxants mivacurium would seem to be most appropriate for caesarean section.
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Int J Obstet Anesth · Jan 1998
Convulsions in a healthy parturient due to intrapartum water intoxication.
Water intoxication during pregnancy is an uncommon event, usually associated with iatrogenic fluid overload, the prolonged administration of high doses of oxytocin or psychiatric disorder. This case report describes water intoxication presenting as the sudden onset of grand mal convulsions in the immediate postpartum period, after a normal delivery in a healthy parturient. The most likely explanation was an excessive voluntary ingestion of large quantities of water and hypotonic fluids during labour.
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Int J Obstet Anesth · Jan 1998
Cough stress rib fractures in two obstetric patients: case report and pathophysiology.
The clinical presentation of fractured ribs and physiology of cough in two obstetric patients are described to explain why a rib fracture, not a pneumothorax, occurred on coughing in these patients. At total lung capacity the outward expansion of the lower thorax (flare) during a cough is limited. ⋯ A direct expiratory action of abdominal muscles predominates over their indirect inspiratory action. The lower ribs are pulled down by the cough and may even fracture from the enormous intrapleural cough pressures which are generated before the glottis opens.
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Int J Obstet Anesth · Oct 1997
Obstetric anaesthesia: an approach to improving the standards of services.
There has been considerable discussion about obstetric anaesthesia standards and about the role of peer review in quality improvement. We carried out two postal surveys in 1990 and 1991 in major obstetric departments in Northern England, in order to assess practice and facilities against professionally derived standards, with the aim of stimulating and reviewing change. The reference standards were a local adaptation of those produced by the Obstetric Anaesthetists Association, and covered operating facilities, anaesthetic equipment, management and manpower, training, and protocols. ⋯ This revealed further improvement in 8/26 standards, but apparent deterioration in 11/26. The overall change from the first to the third survey was of apparent improvement in 15/26 standards and deterioration in 6/26. Surveys of practice against professionally derived standards and the targeted feed back of results can lead to improvements in practice and facilities.