Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural fentanyl and caesarean section: when should fentanyl be given?
Epidural fentanyl is often added to epidural local anaesthetic agents to improve the quality of anaesthesia obtained during Caesarean section. Fentanyl may be given either before or after delivery of the infant. When given before delivery, fentanyl has not been reported to cause neonatal depression, although this remains a concern. ⋯ Neonates were assessed by umbilical arterial blood pH and Apgar scores. No differences were detected in either group with respect to maternal or neonatal outcome. We recommend using only epidural local anaesthetic agents before delivery, and giving epidural fentanyl following delivery of the infant.
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Letter Case Reports
[Cerebral pneumatocele after peridural anesthesia in an obstetrical setting].
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Randomized Controlled Trial Comparative Study Clinical Trial
Supplemental maternal oxygen therapy during caesarean section under epidural anaesthesia: a comparison of nasal prongs and facemask.
Forty healthy parturients at term, undergoing elective Caesarean section, were divided into two groups to receive supplemental oxygen by either simple facemask (Group FM, 8 L.min-1) or nasal prongs (Group NP, 4 L.min-1) during the procedure. Anaesthesia was provided by epidural block to equivalent dermatomal levels in all patients. Maternal oxygen saturation was measured continuously with pulse oximetry and supplemental oxygen was provided to the mother after administration of the epidural test dose and continued until the end of the procedure. ⋯ There was no difference in the clinical condition of the neonates, as assessed by Apgar scores, or in the acid-base and oxygenation status, as assessed by blood gas analyses between the two groups. Mean umbilical vein oxygen saturation, a measure of fetal oxygen delivery, was 46 +/- 18% (95% confidence interval 39% to 54%) for Group NP and 54 +/- 17% (95% confidence interval 46% to 62%) for Group FM, again not different. We conclude that when the clinical condition, acid-base and oxygenation status of neonates, delivered by elective Caesarean section to healthy, low-risk parturients with normal placental function under epidural anaesthesia, are evaluated, it makes no difference whether the mothers received supplemental oxygen by nasal prongs or simple facemask.
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Comparative Study Clinical Trial Controlled Clinical Trial
Bupivacaine 0.1% does not improve post-operative epidural fentanyl analgesia after abdominal or thoracic surgery.
Epidural infusions of fentanyl, in a 10 micrograms.ml-1 concentration, combined with bupivacaine 0.1% were compared with epidural infusions of fentanyl alone for postoperative analgesia following abdominal or thoracic surgery. There were no detectable differences between the two groups in analgesia (mean visual analogue scale pain scores ranging between 15-35 mm), average infusion rates of 7-9 ml.hr-1, and serum fentanyl concentrations which reached 1-2 ng.ml-1. ⋯ Of the patients receiving fentanyl and bupivacaine 0.1%, three developed a transient unilateral sensory loss to pinprick and ice, and two of these patients had unilateral leg weakness equal to a Bromage 1 score. The addition of bupivacaine 0.1% does not improve epidural infusions of fentanyl using a 10 micrograms.ml-1 concentration following abdominal or thoracic surgery.