International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1994
Combined spinal epidural (CSE) analgesia: technique, management, and outcome of 300 mothers.
Epidural analgesia in labour is commonly associated with some degree of lower limb weakness often severe enough to be described as paralysis by the mother. We aimed to produce rapid reliable analgesia with no motor block throughout labour. We report a pilot survey of 300 consecutive women requesting regional analgesia in labour who received a combined spinal epidural blockade (CSE). ⋯ Transient hypotension occurred in 24 women (8%) and was treated with 6 mg intravenous boluses of ephedrine. Complete satisfaction with analgesia and mobility was reported 12-24 h post partum by 95% of mothers. The use of this analgesic technique caused no alteration in obstetric management or post partum care of the women.
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Int J Obstet Anesth · Apr 1994
Low dose intrathecal morphine and pain relief following caesarean section.
Healthy women who underwent caesarean section under spinal anaesthesia were studied to determine the extent of postoperative analgesia and side-effects produced by low doses of intrathecal morphine. Patients were randomly allocated to receive, in double-blind fashion, 0 mg (group 1: control group), 0.05 mg (group 2), 0.1 mg (group 3), or 0.2 mg (group 4) of morphine, with 10 mg tetracaine in 10% dextrose 2.5 ml. (n = 20 x 4 groups). The effect of intrathecal morphine was examined in terms of the duration until the first supplemental analgesic was needed and the numbers of the doses within the first postoperative 48 h. ⋯ No patient developed respiratory depression. Our results suggest that postoperative analgesia lasts more than 24 h with 0.1 mg or 0.2 mg of intrathecal morphine. Since the incidence of side-effects was higher at 0.2 mg, 0.1 mg may be the optimum dose for caesarean section.
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Int J Obstet Anesth · Apr 1994
Awake fibre optic intubation in a 38-week pregnant patient with submandibular abscess.
A 38-week pregnant patient with trismus required surgery for drainage of a submandibular abscess. Her anaesthetic management involved an awake fibre optic intubation. We describe below the details of this and discuss the options for management of similar patients.
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Int J Obstet Anesth · Apr 1994
Pregnancy and cirrhosis: management of hematemesis by Warren shunt during third trimester gestation.
Considerable pathophysiologic changes accompany cirrhosis. Elevation of portal venous pressure predisposes to esophageal varices and hematemesis. ⋯ The anesthetic management of a pregnant cirrhotic patient for a Warren shunt is complicated by concerns for pre-existing hepatic dysfunction and pregnancy-induced physiologic changes as well as fetal well-being. The management of such a case is reviewed and relevant pathophysiology discussed.