International journal of obstetric anesthesia
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Int J Obstet Anesth · Sep 1991
The effects of ephedrine and etilefrine on uterine and fetal blood flow and on fetal myocardial function during spinal anaesthesia for caesarean section.
The effects of two vasopressors, ephedrine and etilefrine, on blood flow in maternal uterine, fetal umbilical, middle cerebral and renal arteries and on fetal myocardial function were studied by colour Doppler and M-mode echocardiography techniques during spinal anaesthesia for caesarean section. There were 7 healthy pregnant women in each treatment group. The vascular resistance of maternal uterine arteries increased significantly after both of the vasopressors while the vascular resistance of the umbilical artery remained unchanged. ⋯ Etilefrine caused no detectable changes in fetal haemodynamics or in fetal myocardial function. These findings demonstrate that vasopressors administered for the treatment of minor maternal arterial pressure fall produce vasoconstriction in the uterine circulation during spinal anaesthesia, yet healthy fetuses seem to tolerate these haemodynamic alterations well. On the other hand, ephedrine caused changes in fetal myocardial function and in the vascular resistance of fetal middle cerebral and renal arteries, which demonstrates the potential modifying effect of vasoactive drug given to the mother on fetal haemodynamics.
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Int J Obstet Anesth · Sep 1991
A comparison of epidural diamorphine with intramuscular papaveretum following caesarean section.
Following caesarean section carried out under epidural blockade using local anaesthetic only, 40 consenting women were randomly allocated to receive either epidural diamorphine 2.5-5 mg in 10 ml physiological saline and intramuscular saline or epidural saline and intramuscular papaveretum 10-20 mg, dosage depending on weight, when the pain returned. When analgesia was next requested the alternative treatment was given. A visual analogue pain score was recorded before and 15, 30, 60, 120, 180 and 240 min after the first treatment. ⋯ No difference in respiratory rate was noted but side-effects were more frequent with epidural diamorphine. Despite this more women preferred this treatment. Because of enhanced mobility provided by good analgesia epidural diamorphine is worth offering to women following caesarean section.