Anaesthesia
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General anaesthesia for emergency caesarean section is associated with the shortest time-to-incision but also lower 5-min Apgar scores. Longer time-to-incision is not associated with worse neonatal outcomes.
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Randomized Controlled Trial Comparative Study
Randomised double-blind comparison of bolus phenylephrine or ephedrine for treatment of hypotension in women with pre-eclampsia undergoing caesarean section.
Treatment of post-spinal hypotension during caesarean section assumes special concern in pre-eclamptic patients due to a compromised fetoplacental circulation and increased risk of placental hypoperfusion. Phenylephrine and ephedrine are the most commonly used vasopressors, although the best choice is still not clear. We studied 80 pre-eclamptic women with a singleton pregnancy who underwent caesarean section with spinal anaesthesia, and who developed hypotension defined as a decrease in systolic arterial pressure ≥ 20% from baseline or absolute value < 100 mmHg. ⋯ The incidence of neonatal acidosis (umbilical artery pH < 7.20) was 9 (22.5%) in the phenylephrine group and 11 (27.5%) in the ephedrine group (p = 0.80). Other secondary outcome measures were comparable. In conclusion, phenylephrine 50 μg and ephedrine 4 mg, administered as intravenous boluses to treat post-spinal hypotension during caesarean section in pre-eclamptic patients, resulted in similar fetal acid-base values, were equally effective in treating hypotension and were associated with good maternal and neonatal outcome.
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The i-gelTM is a supraglottic airway with a gel-like thermoplastic cuff. It has been suggested that the seal around the larynx improves following insertion. Perhaps the most intuitive hypothesis proposed for this is that cuff softening occurs during warming from ambient to body temperature. ⋯ Over 10 to 60 °C, the smallest hardness value expressed as a proportion of the largest was 88.2% and 89.8% for size 2 and 3 i-gels, respectively, and for resilience these were 92.8% and 86.2%, respectively. Over room temperature to body temperature range (21-37.4 °C), hardness decreased by 3.15% and increased by 0.47% for i-gel sizes 2 and 3, respectively, whereas resilience values decreased by 1.85% and 2.68%, respectively. Cuff hardness and resilience did generally reduce with warming, but the effect was minimal over temperature ranges that may be encountered during clinical use.