International journal of obstetric anesthesia
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Int J Obstet Anesth · Feb 2020
Randomized Controlled Trial Comparative StudySurgical conditions with rocuronium versus suxamethonium in cesarean section: a randomized trial.
Onset times and conditions for intubation after rocuronium versus suxamethonium at cesarean section have been evaluated, but no study thus far has examined the influence of these neuromuscular blocking drugs on the surgical conditions or their effect on the duration of surgery and the ease of fetal delivery. We aimed to compare the surgical conditions for delivery in parturients who received deep neuromuscular block with rocuronium with those who had induction with suxamethonium. ⋯ Whereas the induction-to-delivery intervals were comparable, we found rocuronium superior to suxamethonium in allowing better surgical conditions for fetal delivery, which enabled an easier delivery and a shorter incision-to-delivery interval.
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Int J Obstet Anesth · Nov 2019
Randomized Controlled Trial Comparative StudyA triple-blinded randomized trial comparing spinal morphine with posterior quadratus lumborum block after cesarean section.
What did they do?
Tamura and team randomised 176 elective CS patients to spinal anaesthesia with or without morphine, in addition to placebo or ultrasound-guided quadratus lumborum block (QLB).
And they found
Only intrathecal morphine significantly improved analgesia, not QLB whether performed with or without spinal morphine. Thus QLB probably does not improve analgesia further beyond current best practices.
Not so fast...
While this modest-sized RCT concluded that QLB did not improve pain after caesarean section, the conclusion is i) somewhat inconsistent with earlier studies that did show benefit, and ii) the adjuvant analgesic regime1 used may not be applicable to practice outside Japan.
summary
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The researchers administered the remaining 90 mcg fentanyl IV, along with droperidol 1.25 mg and acetaminophen/paracetamol 15mg/kg after baby delivery. An NSAID (diclofenac 50mg) was only provided when breakthrough pain was requested. ↩
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Int J Obstet Anesth · Aug 2019
Randomized Controlled Trial Comparative StudyA randomised comparison of C-MAC™ and King Vision® videolaryngoscopes with direct laryngoscopy in 180 obstetric patients.
Current evidence suggests that there is uncertainty about which videolaryngoscope performs best in obstetric anaesthesia. The aim of this study was to compare C-MAC and King Vision® videolaryngoscopes and direct laryngoscopy for tracheal intubation of patients undergoing caesarean section. ⋯ Compared to direct laryngoscopy, C-MAC and King Vision® did not prolong the time to intubation, supporting these videolaryngoscopes as primary intubation devices in obstetric anaesthesia. The C-MAC was easier to use and needed fewer additional manoeuvres than the King Vision®. The C-MAC may be better suited for tracheal intubation of obstetric patients undergoing caesarean section.
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Int J Obstet Anesth · May 2019
Randomized Controlled TrialEffect of companion presence on maternal satisfaction during neuraxial catheter placement for labor analgesia: a randomized clinical trial.
Companion presence during labour epidural placement reduces maternal anxiety and improves maternal satisfaction.
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Int J Obstet Anesth · May 2019
Randomized Controlled Trial Comparative StudyComparison of the potency of phenylephrine and norepinephrine bolus doses used to treat post-spinal hypotension during elective caesarean section.
Phenylephrine, although considered the vasopressor of choice, can cause reflex bradycardia and a fall in cardiac output. Norepinephrine, due to its direct positive chronotropic and reflex negative chronotropic actions, is expected to overcome this problem. However, limited information about its effective dose for management of post-spinal hypotension, and its potency compared to phenylephrine, is available. ⋯ Based on the results of this study, norepinephrine is about 11 times more potent than phenylephrine. When used as bolus doses for treatment of hypotension, 100 μg phenylephrine should be approximately equivalent to 9 μg norepinephrine.