Anaesthesia and intensive care
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Epidural opioids have been used in obstetrics since 1980. Various opioids are reviewed in relation to their pharmacology, their efficacy in labour, during caesarean section and for postoperative analgesia, their side-effects and safety. In this patient population it appears safe to administer epidural opioids on the general ward provided that strict monitoring standards are maintained. Practical considerations of nursing management are discussed.
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Anaesth Intensive Care · Aug 1990
Review Case ReportsPulmonary hypertension and pregnancy--a lethal combination.
Pulmonary hypertension may be either primary of unknown aetiology or secondary to existing cardio-respiratory disease. As a single entity the prognosis is poor but superimposition of the physiological changes of pregnancy and labour produces a lethal condition. This paper sets out two clinical cases of primary pulmonary hypertension as background for discussion to highlight the issues involved. Whatever this discussion does, let it be clearly spelled out that prevention is better than any proposed cure.
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Anaesth Intensive Care · Aug 1990
ReviewEpidural medication after the initial dose: reflections on current methods of administration during labour.
Most women who receive epidural pain relief during labour require additional epidural analgesia following the initial dose. This review examines the relative merits associated with current methods of epidural drug delivery when further analgesia is required. Apart from considerations of patient safety and convenience the review compares the relative flexibility in pain management which can be provided by these different regimens. It is postulated that patient satisfaction is enhanced when the mother has some personal control over the density of neural blockade provided by epidural analgesia.
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Anaesth Intensive Care · Aug 1990
ReviewEpidurals, spinals and bleeding disorders in pregnancy: a review.
Paraplegia caused by spinal haemorrhage is a very rare but disastrous complication of spinal or epidural insertion. The risk in uncomplicated surgical and obstetric patients is outlined. Bleeding disorders in pregnant patients may prevent the use of major regional anaesthesia. Factors which influence the choice of anaesthetic technique for patients with pregnancy-induced hypertension, von Willebrand's disease, and anticoagulation therapy, are discussed.
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Anaesth Intensive Care · Aug 1990
Management of failed endotracheal intubation at caesarean section.
A review of the history of endotracheal intubation and endotracheal tubes is presented and a plan of management of failed endotracheal intubation at caesarean section is described. The importance of preparation for such an event by incorporation of certain features into anaesthesia training programs is emphasised.