International journal of obstetric anesthesia
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Although hypothermia has been reported during epidural anesthesia performed for nonobstetrical surgery or cesarean section, epidural analgesia for labor may lead to hyperthermia. Its incidence, time-course and intensity are influenced by multiple factors including site of measurement, duration of labor preceding epidural analgesia and perhaps ambient temperature and occurrence of shivering. During the first 2-5 h of epidural analgesia, a significant increase in temperature is not usually observed. ⋯ However, fetal tachycardia may occur and the potential for a deleterious effect on the fetus remains controversial. Various measures for cooling the mother have been proposed but their efficacy has not been evaluated. The recognition that epidural analgesia may provoke hyperthermia may help to avoid inappropriate use of antibiotics or fetal extraction.
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Int J Obstet Anesth · Jan 1997
Clinical Trial Controlled Clinical TrialPerioperative analgesia for caesarean section: comparison of intrathecal morphine and fentanyl alone or in combination.
In a double-blind placebo-controlled trial we compared perioperative pain relief using different intrathecal opioid regimens given with bupivacaine during spinal anaesthesia for elective caesarean section. One hundred and sixteen patients undergoing elective caesarean section were divided into four groups (A, B, C, D) of 29 patients each. In addition to hyperbaric bupivacaine (12-14 mg), group A received 1 ml of normal saline, group B 25 microg of fentanyl, group C 100 microg of morphine, and group D received both fentanyl 25 microg and morphine 100 microg intrathecally. ⋯ The use of the opioids in association, however, was found to increase the incidence of side-effects. The quality of postoperative analgesia with fentanyl, when used alone, was found to be inferior to that with morphine. The combination of opioids offered no advantage over morphine alone.
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Int J Obstet Anesth · Jan 1997
Determination of the minimum local analgesic concentration of epidural chloroprocaine hydrochloride in labor.
The aim was to determine the effective concentration in 50% of patients (EC(50)) of chloroprocaine in the first stage of labor. A constant dose modification of a model where EC(50) was previously defined as the minimum local analgesic concentration (MLAC) was used. Parturients (n = 36) requesting epidural analgesia in labor, at cervical dilatation not exceeding 7 cm, were enrolled into this prospective, double-blinded study. ⋯ MLAC (95%CI) was 0.42%w/v (0.34 to 0.5) using the formula of Dixon & Massey and as a sensitivity test was 0.4%w/v (0.35 to 0.46) using probit regression analysis. In conclusion, MLAC of chloroprocaine was 0.42%w/v in these parturients, equivalent to 14 millimolar solution. This study confirmed that concentration rather than dose could be used as a measure of efficacy in this constant dose model.
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Int J Obstet Anesth · Jan 1997
Spinal anesthesia versus intravenous sedation for transvaginal oocyte retrieval: reproductive outcome, side-effects and recovery profiles.
Transvaginal ultrasonically guided oocyte retrieval is commonly performed as part of in vitro fertilization efforts. The impact of anesthetic management on patient outcome from this procedure has not been well characterized. At our institution, patients are offered a choice of either heavy intravenous sedation or spinal anesthesia with minimal or no sedatives. ⋯ The intravenous sedation group required a significantly longer period until recovery room discharge criteria were met (P = 0.03), and were more likely to have postoperative emetic episodes (46% versus 6% in the spinal anesthesia group: P < 0.01). Two unplanned hospital admissions occurred in the intravenous sedation group: both were related to uncontrolled nausea and vomiting. We conclude that spinal anesthesia may have advantages over intravenous sedation for oocyte retrieval.