Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The number of parturients receiving epidural anaesthesia in university medical centres is increasing. This trend is not paralleled in rural hospitals. Obstetrical epidural anaesthesia as provided in a 40-bed, remote hospital is reviewed for the ten-year period from January 1974 to December 1983. ⋯ Ninety per cent of this group received systemic sedation or narcotics prior to epidural catheter insertion. Nineteen patients (16.3 per cent) experienced a major complication, including four dural punctures (3.4 per cent), ten episodes of significant hypotension (8.6 per cent), blood vessel puncture during catheter insertion in four patients (3.4 per cent), and transient paresthesia in one patient (0.8 per cent). Considerations for the provision of epidural anaesthesia in a remote hospital are discussed.
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Clinical Trial Controlled Clinical Trial
The effect of pH adjustment of bupivacaine on onset and duration of epidural anaesthesia for caesarean section.
Previous studies have reported that elevation of the pH of local anaesthetics results in more rapid onset of action, with enhanced quality and duration of block. This study investigated the effect of pH adjustment of 0.5 per cent bupivacaine immediately prior to epidural anaesthesia for Caesarean section. Addition of 0.1 ml of 8.4 per cent sodium bicarbonate to 20 ml of 0.5 per cent bupivacaine consistently raised the pH of the local anaesthetic from 5.49 to 7.04 (mean values). ⋯ The time to S2 segment blockade was also shortened from 13.5 to 8.6 minutes. Addition of 1:400,000 epinephrine to the local anaesthetic did not influence the effect of pH adjustment. Maternal and umbilical cord plasma levels of bupivacaine were not affected by pH adjustment of the local anaesthetic, while MV/UV and UA/UV ratios were unaltered.
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To determine whether capnographic waveforms can characterize valve malfunction of the anaesthesia circle, which would enable such problems to be identified and rectified immediately, we monitored capnographic respiratory waveforms during anaesthesia with simulated circle valve malfunctions. Ten mongrel dogs were anaesthetized with pentobarbitone, 25 mg.kg-1 IV, and halothane, 0.5 to 1 per cent. Respiratory gas was sampled from the elbow of the circle system for capnographic monitoring. ⋯ Inspired CO2 increased to almost 1 per cent when the inspiratory valve was open and to greater than or equal to 1.89 per cent when the expiratory valve was open. The effects with the expiratory valve open and with both valves open were similar. Capnograms were affected in characteristic ways by the valve malfunctions.