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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Continuous electrocardiographic monitoring was performed in 20 term parturients during labor, vaginal delivery, and recovery. Mean duration of monitoring was 13.37 h. ⋯ Eight patients exhibited premature ventricular contractions or supraventricular tachycardia. ST-segment depression was noted in 3 patients (15%); in all 3, this was concurrent with maximum heart rate, was not associated with any symptoms, and occurred in the post-partum period.
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Int J Obstet Anesth · Apr 1994
Continuous arteriovenous hemofiltration in the treatment of amniotic fluid embolism.
Continuous arteriovenous hemofiltration (CAVH) was successfully used in a 35-year-old woman, who had developed amniotic fluid embolism in the course of a premature labor and cesarean delivery. With CAVH, the pulmonary artery pressure decreased, the cardiac index rose, and the arterial oxygenation improved dramatically. This technique seems to be an important contribution to the management of amniotic fluid embolism.
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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.