Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The authors evaluated the accuracy of an intrathecal test dose (TD) to rule out unintentional subarachnoid injection in a prospective and double-blind study. Twenty-nine unmedicated patients scheduled to receive continuous spinal analgesia for their surgical procedures entered the study. After placement of non-invasive monitoring (ECG, BP and SpO2), an intrathecal catheter was placed in the lumbar area. ⋯ At four minutes SN reached 100% (CI 78-100%) for R and H, while only R obtained a SP of 93% (CI 66-100%). Using R as detector of intrathecal injection the -PV was 100% and the +PV 25% (assuming a 2% prevalence of unintentional spinal). We conclude that, with our test dose; (a) four minutes are needed to recognize signs of intrathecal injection; (b) leg-raising is a reliable sign; and (c) inquiring about other signs may only decrease the diagnostic accuracy of this test.
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The purpose of this report is to describe a new complication of epidural blood patch for inadvertent dural puncture. A dural tap in an obstetric patient was managed initially with a prophylactic blood patch via the epidural catheter. Despite this, 48 hr later, she developed post-dural puncture headache, neck, and shoulder pain, and was given a second epidural blood patch. ⋯ There were no further sequelae. Although severe complications of epidural blood patch are rare, they are alarming. Exacerbation of the original symptoms of post-dural puncture headache caused by, or following, epidural blood patching has not previously been reported.
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The use of epidural analgesia has become so widespread in recent years that many women are now requesting repeat epidural analgesia for their second or subsequent labour. This study examines the incidence of problems at insertion and of inadequate block in 71 multiparae having second epidurals compared with 150 primiparae having their first epidural. ⋯ Epidurals were inserted at a greater dilatation (P < 0.05) and there was a shorter time to delivery (P < 0.01) in the multiparous group. We conclude that unilateral block is thus more common in women receiving repeat epidurals.
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Comment Letter
The oesophageal tracheal combitube for difficult intubation.
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Case Reports
Complications of continuous epidural infusions for postoperative analgesia in children.
To determine the incidences of side effects and complications associated with the use of epidural analgesia for infants and children at the Alberta Children's Hospital, we reviewed our experience over a two-year period. A database was established for recording management, side effects and complications of each epidural, and this is a retrospective review of that database. Problems were identified as complications if there was a need for medical intervention related to the patient complaint, and if the intervention was documented in the patient record. ⋯ Early discontinuation of the epidural occurred in 41 cases, technical problems with the epidural catheter being the commonest reason (21 cases). Although three potentially serious complications were identified (one catheter site infection, one seizure, one respiratory depression) none was associated with lasting consequences. The majority of complications associated with the use of epidurals were minor and easily remedied.(ABSTRACT TRUNCATED AT 250 WORDS)