International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 1997
Randomized Controlled Trial Clinical TrialA double-blind assessment of the analgesic sparing effect of intrathecal diamorphine (0.3 mg) with spinal anaesthesia for elective caesarean section.
In a randomized double-blind study, 40 healthy women undergoing elective caesarean section with spinal anaesthesia received either 0.3 mg diamorphine or saline with bupivacaine 0.5% in 8% dextrose. The study recorded time to the first morphine demand delivered by patient-controlled analgesia (PCA), and total morphine requirement over 24 h. In addition pain, sedation, and pruritus were assessed by non-graduated visual analogue scores (VAS). ⋯ The medians (interquartile ranges) were 5 (0, 36) mg vs 45 (26, 72) mg (P 0.0045, 95% confidence interval for the difference between the medians is 12 to 46 mg). In the diamorphine group, postoperative VAS for pain was significantly lower at 2 h and 3 h both at rest (P 0.0003, 0.003) and on moving (P 0.009, 0.002), at 8 h on moving (P 0.01), and at 12 and 24 h at rest (P 0.005, 0.029). Significantly more women suffered pruritus in the diamorphine group for the first 12 h after surgery (P 0.01).
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Int J Obstet Anesth · Oct 1997
Factors involved in the incidence of post-dural puncture headache with the 25 gauge Whitacre needle for obstetric anesthesia.
Parturients have the greatest risk of postdural puncture headache. use of a pencil-point needle, such as the 25 gauge Whitacre, has been associated with a lower incidence of PDPH. This observational study of 1009 obstetrical patients assessed possible factors related to the incidence of PDPH and other complications associated with spinal anesthesia using the 25 gauge Whitacre needle. The independent variables included procedure, maternal position at insertion, ease of insertion, intraoperative i.v. analgesia supplementation, use of intrathecal narcotics, parity and type of local anesthetic. ⋯ Six patients (0.59%) required epidural blood patch. There were eight (0.8%) failed finals which were converted to general anesthesia. None of the factors evaluated were significant in predicting the occurrence of PDPH.
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Int J Obstet Anesth · Oct 1997
Anaesthetic management of caesarean section in a parturient with acute myelodysplastic syndrome.
A 34-year-old pregnant woman developed a myelodysplastic syndrome during pregnancy which resulted in a refractory anaemia and an extreme thrombocytopenia. The report describes the anaesthetic management of elective caesarean section and successful childbirth in this patient. Following replacement therapy with packed red cells and platelets, general anaesthesia was used for the procedure.