International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 1995
Fiberoptic intubation using intraoral glossopharyngeal nerve block in a patient with severe preeclampsia and HELLP syndrome.
Rationale and technique for use of intraoral glossopharyngeal nerve block is described in a parturient with severe preeclampsia and a past history of difficult intubation. Indications and contraindications for administration of other forms of airway anesthesia are discussed.
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Int J Obstet Anesth · Jul 1995
Serious complications associated with epidural/spinal blockade in obstetrics: a two-year prospective study.
A prospective study of complications associated with epidural and spinal blockade in obstetrics was carried out during the years 1990 and 1991. 79 obstetric units in the United Kingdom took part. These units had a total of 467 491 deliveries during the two years. 108 133 mothers received epidural blockade and 14856 received spinal blockade. 22% of all mothers received epidural analgesia in labour, and 50% of caesarean sections were performed under either epidural or spinal anaesthesia. 128 complications (not including post dural puncture headache) were reported. Of these, 46 were neuropathies involving a single spinal or peripheral nerve. 26 unexpectedly high blockades were encountered. ⋯ Although resuscitation restored normal cardiac function in both cases, one patient was decerebrate and died some days later. Postmortem examination revealed evidence of amniotic fluid embolus. 20 reports were classified as 'miscellaneous' and presented individual clinical diagnoses. The overall complication rate (excluding post dural puncture headache) was approximately 1 per thousand.
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Int J Obstet Anesth · Jul 1995
Transfer of the critically ill obstetric patient: experience of a specialist team and guidelines for the non-specialist.
Transfer of the critically ill obstetric patient between hospitals is increasingly common. The specialist transfer team based at the Western Infirmary Intensive Therapy Unit, Glasgow has transported 60 such patients in the years 1985-1994. Monitoring was by direct arterial pressure measurement in 56 patients and central venous pressure measurement in 45. ⋯ The majority of patients had pregnancy induced hypertension or had suffered a post partum haemorrhage. A clinical impression that these two groups had different treatment requirements and outcomes was not substantiated. We conclude that the transfer of even the sickest obstetric patient is feasible and safe and suggest guidelines to non-specialists for the management of these patients before and during interhospital transfer.
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Int J Obstet Anesth · Jul 1995
Epidural clonidine-fentanyl combination for labour analgesia: a comparison with bupivacaine-fentanyl.
This open study of 20 women compared epidural clonidine (300 microg)/fentanyl (100 microg) with bupivacaine (25 mg)/fentanyl (100 microg) in the provision of pain relief in labour. Sensory tests in the clonidine group revealed slight alterations in the appreciation of pin prick and temperature but motor power was unchanged. ⋯ Midwives also commented favourably on the normal mobility of these labouring mothers. There was no difference between the two groups in the duration of labour or the condition of the infants.