International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1994
Prevention of hypotension during spinal anaesthesia for caesarean section.
Twenty-six parturients scheduled to receive spinal anaesthesia for caesarean section were randomized to receive either isotonic saline 750 ml plus 20 ml/kg (group A) or 750 ml plus 500 ml (group B) before subarachnoid administration of bupivacaine 13 mg. Ephedrine 0.15 mg/kg i.v. followed by an infusion 0.4 mg.kg(-1) h(-1) were then administered in group B. In both groups ephedrine 10 mg/min i.v. was given if the mean arterial blood pressure decreased more than 10 mmHg. ⋯ One neonate in group A and 2 in group B were acidotic. In conclusion, a reduced volume loading could be compensated with an increased ephedrine administration after induction of spinal anaesthesia, without increasing the incidence of hypotension or other maternal or neonatal complications. However, the fluid volumes and/or ephedrine doses used were not sufficient to prevent hypotension altogether.
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The cardiovascular changes during epidural caesarean delivery were studied, using a non-invasive cardiac output monitor (BoMed NCCOM3-R7). Two different regimens were used to control hypotension (A = 15 ml/kg of 3% dextran 70, B = 7.5 ml/kg of 3% dextran 70 followed by an infusion of 17.5 mg of ephedrine). ⋯ The increase in cardiac output after delivery was greater than that measured previously, which might be because impedance cardiac output is a continuous method. It is also suggested that the most pronounced changes are augmented by the use of a bolus injection of 10 units oxytocin i.v.
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Int J Obstet Anesth · Jan 1994
A comparison of spinal and general anaesthesia for elective caesarean section: effect on neonatal condition at birth.
The condition of 74 neonates delivered by elective caesarean section under general anaesthesia was compared with that of 63 neonates delivered under spinal anaesthesia. When the uterine incision - delivery interval was less than 3 min, neonates in the spinal group exhibited a higher Apgar score at 1 min (P < 0.002) and a higher mean umbilical venous pH (P < 0.05) than the equivalent general anaesthesia group; a significantly greater proportion of the neonates delivered under general anaesthesia had an umbilical venous pH<7.28 at delivery (P < 0.05), a fact which previous work suggests is important. Among anaesthetized mothers inspired oxygen concentration (33% or 50%) before delivery had no significant effect upon neonatal outcome. It is concluded that neonates delivered at elective Caesarean section under spinal anaesthesia are in better condition than those delivered under general anaesthesia.
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In parturients, extension of epidural analgesia to include the sacral roots is necessary for adequate analgesia during the second stage of labour and for vacuum extraction and forceps delivery. There is clinical evidence that if the sitting position is adopted after local anaesthetic administration, it impairs the sacral spread of analgesia. An in vitro model representing the lumbar spinal canal has been used to demonstrate how, in the vertical position, a CSF plug can prevent downward spread of local anaesthetic. ⋯ Sacral sensory blockade was greater in the head up group. The difference was significant on the left side (P < 0.05) at 15, 20, and 30 minutes after the main dose. There were more patients with blocks extending to S5 (on either the left or right sides) in the head up group at 15, 20 and 30 minutes (P < 0.05 at 20 and 30 minutes on left side).
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Int J Obstet Anesth · Jan 1994
Acute tissue damage following epidural cannulation: a comparison between the midline and paramedian approach in obstetric patients.
Forty obstetric patients were randomly allocated to receive either a midline or paramedian approach to the epidural space using loss of resistance to air. Tissue trauma was assessed by blinded observers, clinically by the presence of pain and radiologically using magnetic resonance imaging (MRI). ⋯ There was no significant difference in localized back pain between the two groups, and this was not related to MRI findings. Pain did not persist for more than 4 days.