Anaesthesia
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Review Meta Analysis
Anaesthesia for Caesarean section and neonatal acid-base status: a meta-analysis.
Spinal anaesthesia is generally preferred for Caesarean section. Its superiority for the baby is often assumed. Umbilical artery acid-base status provides a valid index of fetal welfare. ⋯ Larger doses of ephedrine contributed to the latter effect (p = 0.023). Sixteen studies reported a base deficit, which was significantly higher for spinal than for general (difference 1.109; 95% CI 0.434-1.784 mEq.l(-1); seven studies, 695 subject) and epidural anaesthesia (difference 0.910; 95% CI 0.222-1.598 mEq.l(-1); seven studies, 497 subjects). Spinal anaesthesia cannot be considered safer than epidural or general anaesthesia for the fetus.
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Comparative Study Clinical Trial Controlled Clinical Trial
Movement of the upper cervical spine during laryngoscopy: a comparison of the Bonfils intubation fibrescope and the Macintosh laryngoscope.
The movements of the upper cervical spine were measured by fluoroscopy in 20 patients during laryngoscopy with the Bonfils intubation fibrescope and the Macintosh laryngoscope. Laryngoscopy with both the Bonfils intubation fibrescope and the Macintosh laryngoscope resulted in significant extension of the cervical spine as compared to the neutral position but this extension was significantly less with the Bonfils intubation fibrescope than with the Macintosh (p = 0.001). ⋯ With the Bonfils intubation fibrescope, significantly less extension was also found at the C1/C2 and C3/C4 levels (p = 0.001 and p = 0.049, respectively). There is therefore significantly less movement of the upper cervical spine during laryngoscopy with the Bonfils fibrescope compared with the Macintosh laryngoscope.
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Multicenter Study
The management of accidental dural puncture during labour epidural analgesia: a survey of UK practice.
The management of accidental dural puncture and postdural puncture headache in obstetric practice continues to be of great interest. This survey aims to explore the current management of this complication in the United Kingdom and compares the findings to a similar survey undertaken in 1993. A postal questionnaire was sent to all maternity units (n = 248). ⋯ Only 44 units (26%) now treat postdural puncture headache with an epidural blood patch as soon as it is diagnosed, whereas in 120 units (71%) the blood patch is performed only after failure of conservative measures. Due to the large increase in the use of the intrathecal catheter following this complication, a follow-up questionnaire was posted 5 months later to those units (n = 99) that reported this practice in the initial survey, with a 94% response rate. The two most commonly cited reasons for intrathecal catheterisation were to avoid further dural puncture (76%) and to allow immediate analgesia for labour (75%).
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Postoperative pain is an important clinical problem that has received increasing attention in recent years. However, pain following craniotomy has been a comparatively neglected topic; this review seeks to redress this imbalance. ⋯ A comprehensive search of the literature was undertaken to ascertain the incidence of acute pain post craniotomy and current thoughts on pharmacological management, touching briefly on pre-emptive treatment. Also discussed is the much neglected but nevertheless real incidence of chronic pain following craniotomy and its underlying pathogenesis, prevention and treatment.
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Comment Letter Case Reports
Transient fixation on a non-native language associated with anaesthesia.