International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 1997
An unusual complication following combined spinal-epidural anaesthesia for caesarean section.
The combined spinal-epidural technique is widely used in obstetric anaesthetic practice. Epidural catheter migration through a dural hole is a theoretical but rarely described complication. We report a case of acute and life-threatening respiratory depression following administration of diamorphine through an epidural catheter after a single space combined spinal-epidural technique for caesarean section. We believe this complication occurred as a result of catheter migration through a dural hole into the subdural space and rupture of the thin arachnoid layer causing massive subarachnoid blockade.
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Int J Obstet Anesth · Jul 1997
Randomized Controlled Trial Clinical TrialFeto-maternal distribution of ropivacaine and bupivacaine after epidural administration for cesarean section.
Ropivacaine is a new amino amide local anesthetic less lipophilic and with a lower affinity for plasma proteins than bupivacaine. The purpose of this study was to examine the feto-maternal distribution of ropivacaine and bupivacaine after epidural administration for cesarean section. Healthy parturients were randomly allocated in a double-blinded manner to receive either 0.5% ropivacaine or 0.5% bupivacaine through a lumbar epidural catheter. ⋯ At delivery, the maternal free plasma concentration of ropivacaine was more than twice that of the free concentration of bupivacaine (0.072 vs 0.032 microg/ml, P = 0.002). The free concentration of ropivacaine was about twice that of bupivacaine in the umbilical venous (0.06 vs 0.03 microg/ml, P = 0.001) and umbilical arterial (0.05 vs 0.02 microg/ml, P = 0.007) plasma. The more rapid plasma clearance of bupivacaine compared to ropivacaine, leading to lower maternal plasma concentrations and hence to lower umbilical concentrations at delivery, could be explained by the higher lipid solubility, hence greater distribution volume, of bupivacaine.
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We conducted a questionnaire survey amongst midwives working in the labour wards of two hospitals within the Trent region. The results show that most of these midwives undertake the care of postoperative patients infrequently and have received little, if any, training. Also, most had not received any guidelines on which to base their practice. ⋯ In one hospital, over 90% used an automated blood pressure monitor and pulse oximeter. In the second hospital this happened in only 50% of cases. There appears to be some confusion regarding the monitors used postoperatively in that 11% of midwives said that they routinely used a capnometer in this situation.
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Int J Obstet Anesth · Jul 1997
Severe respiratory depression in the obstetric patient after intrathecal meperidine or sufentanil.
Two cases of severe respiratory depression in the obstetric population are presented. The first occurred after intrathecal injection of a modest dose (50 mg) of meperidine. The second followed intrathecal administration of 10 microg of sufentanil after intravenous fentanyl. These cases illustrate the potential gravity of this complication and highlight the need for caution when giving intrathecal opioid following parenteral opioid administration.