International journal of obstetric anesthesia
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Aspiration is a common clinical entity whose consequences range from the relatively benign to fulminant acute respiratory failure and death. Clinical situations in which airway protection is lost or compromised predispose patients to aspiration. ⋯ When mechanical ventilatory support is required, the avoidance of iatrogenic complications, including worsening lung injury, becomes especially important. Preventative measures, either to minimize the chances of aspiration, or to reduce the potential for injury consequent to aspiration may be highly effective in reducing the incidence of aspiration syndromes.
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Int J Obstet Anesth · Jan 1993
Is opioid loading necessary before opioid/local anaesthetic epidural infusion? A randomized double-blind study in labour.
The effects of two different epidural loading doses administered before starting an opioid/low dose local anaesthetic infusion were examined in a randomized double-blind study during labour. Forty mothers were given either 10 ml 0.25% plain bupivacaine or 10 ml 0.125% plain bupivacaine containing 5 mcg of sufentanil followed in all cases by epidural infusion of 0.08% plain bupivacaine containing 0.2 mcg/ml of sufentanil, which was continued into the second stage. The quality of analgesia did not differ significantly between the groups in either the first or the second stage of labour: in each group 75% of women required 0 or 1 top-up during labour and verbal numerical pain scores were similar. ⋯ There was no difference in the degree of maternal satisfaction assessed 24 hours after delivery, with 80% of women in each group awarding the maximum verbal numerical score for their satisfaction with epidural analgesia. The incidence of maternal side effects (nausea, vomiting, drowsiness and pruritus) was similar in the 2 groups as was neonatal outcome, assessed by Apgar and neurological and adaptive capacity scores and umbilical artery and vein pH. We conclude that opioid loading before opioid/low-dose bupivacaine epidural infusions is unnecessary.
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Int J Obstet Anesth · Jan 1993
Patient controlled epidural analgesia during labour: choice of solution.
Epidural characteristics, when using different solutions for patient controlled epidural analgesia (PCEA), were compared in a randomised, blinded study in labour. Women in group 1 (n=23) self-administered 0.25% plain bupivacaine, in group 2 (n=23) 0.125% plain bupivacaine plus fentanyl 3 microg/ml and in group 3 (n=20) 0.0625% bupivacaine with adrenaline 1:250,000 plus fentanyl 3 microg/ml. ⋯ The rate of bupivacaine utilisation was significantly higher in group 1 compared to groups 2 and 3 and lower in group 3 compared to 1 and 2 (median+interquartile range: 16+11-21 vs 9+6-11 vs 4+3-8 mg/hr, P<0.0002). Although all solutions provided effective pain relief for PCEA during labour, the use of a low-dose bupivacaine-fentanyl combination offers clinical advantages and further evaluation of such solutions is warranted.