International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 1994
Anesthetic management of a parturient with mixed mitral valve disease and uncontrolled atrial fibrillation.
This case report describes the anesthetic management of a 32-year-old parturient with combined severe mitral regurgitation and moderate mitral stenosis, complicated by fast atrial fibrillation. The advantageous effects of epidural analgesia during labor and vaginal delivery and the importance of invasive monitoring are discussed. We also report the rare complication of right bundle branch block related to the use of a pulmonary artery catheter.
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A modification to a computer based system of audit, widely used in anaesthesia for general surgery, is described, which permits a more detailed analysis of obstetric anaesthetic workload. By adjusting entries, in the operation input field, further information can be collected automatically. ⋯ It identifies the total number of caesarean sections, including anaesthetic technique and whether an epidural catheter was, in any case, present. This modification may be applicable to other computerised audit systems.
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Int J Obstet Anesth · Apr 1994
Low dose intrathecal morphine and pain relief following caesarean section.
Healthy women who underwent caesarean section under spinal anaesthesia were studied to determine the extent of postoperative analgesia and side-effects produced by low doses of intrathecal morphine. Patients were randomly allocated to receive, in double-blind fashion, 0 mg (group 1: control group), 0.05 mg (group 2), 0.1 mg (group 3), or 0.2 mg (group 4) of morphine, with 10 mg tetracaine in 10% dextrose 2.5 ml. (n = 20 x 4 groups). The effect of intrathecal morphine was examined in terms of the duration until the first supplemental analgesic was needed and the numbers of the doses within the first postoperative 48 h. ⋯ No patient developed respiratory depression. Our results suggest that postoperative analgesia lasts more than 24 h with 0.1 mg or 0.2 mg of intrathecal morphine. Since the incidence of side-effects was higher at 0.2 mg, 0.1 mg may be the optimum dose for caesarean section.