International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1999
Randomized Controlled Trial Clinical TrialCentral neuraxial opioid analgesia after caesarean section: comparison of epidural diamorphine and intrathecal morphine.
In a prospective, randomized, double-blind study in 55 women undergoing elective caesarean section under spinal anaesthesia, we compared epidural diamorphine 3 mg (2 distinct boluses, group ED) with single-dose intrathecal morphine 0.2 mg (group SM), in terms of analgesic efficacy, patient satisfaction and side-effects at 2, 3, 4, 8, 12, 16, 24 and 28 h postoperatively. There were no significant differences between groups in pain (assessed by 100 mm visual analogue scale), incidence of pruritus, sedation or respiratory depression measured by continuous pulse oximetry. However, time to first request for supplementary oral analgesia was longer in SM than in ED (mean +/- SD: 22.3+/-12.0 h vs. 13.8+/-6.5 h, P=0.04). ⋯ In ED, the mean +/- SD time to requirement of the second bolus was 6.7+/-3.2 h. There was a high level of satisfaction in both groups. We conclude that two boluses of epidural diamorphine 3 mg and single-dose intrathecal morphine 0.2 mg provide satisfactory analgesia after caesarean section, but spinal morphine was associated with both delayed requirement for supplementary analgesia and a higher incidence of nausea and vomiting.
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Int J Obstet Anesth · Apr 1999
Awake fibreoptic intubation, airway compression and lung collapse in a parturient: anaesthetic and intensive care management.
A 28-year-old primigravida at 35 weeks gestation with acute onset of dyspnoea and stridor due to an intrathoracic neoplasm required semi-urgent caesarean section to allow diagnosis and treatment. Her inability to lie supine precluded regional anaesthesia. She underwent awake fibreoptic oral intubation followed by general anaesthesia. This was complicated by desaturation, high airway pressures, unilateral lung collapse, venous congestion and unexpected blood loss due to an undiagnosed placenta praevia.
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Int J Obstet Anesth · Apr 1999
Post partum creatine phosphokinase and its muscle-brain isoenzyme elevation and transient Q-wave in a patient with idiopathic hypertrophic subaortic stenosis.
A primigravida with idiopathic hypertrophic subaortic stenosis, New York Heart Association Classification III, developed acute chest pain with significant ST segment depression together with a new Q-wave in chest lead V6 on the electrocardiograph following delivery under lumbar epidural analgesia. An intrapartum myocardial infarct was suspected because serial creatine phosphokinase and its muscle-brain isoenzyme levels were elevated in the postpartum period. ⋯ Consequently, the elevations of creatine phosphokinase and its muscle-brain fraction alone are not diagnostic of myocardial infarction in the postpartum period. The diagnosis of myocardial infarction must be based on the clinical picture, serial electrocardiogram recording and determination of lactate dehydrogenase and aspartate amino transferase.
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Int J Obstet Anesth · Apr 1999
Necrotising fasciitis and group A streptococcus toxic shock-like syndrome in pregnancy: treatment with plasmapheresis and immunoglobulin.
A 30-year-old woman at 25 weeks gestation presented to the labour ward complaining of abdominal pain and a painful bruise in her right groin. Over the course of several hours, she developed rapidly spreading necrotising fasciitis of the right thigh. She required emergency radical debridement of the thigh and caesarean delivery of a dead fetus. ⋯ Despite the development of acute renal failure, acute respiratory distress syndrome and a left hemiplegia, the patient made a remarkable recovery. She was later transferred to a plastic surgical unit for split skin-grafting. The importance of early diagnosis and aggressive treatment of GAS TS-LS is emphasized and the place of plasmapheresis and intravenous immunoglobulin therapy in this condition is discussed.