International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1995
Comparison of fentanyl with clonidine as adjuvants for epidural analgesia with 0.125% bupivacaine in the first stage of labor: a preliminary report.
48 primiparae received epidural analgesia in labor with 10 ml of 0.125% bupivacaine with epinephrine 1:800 000, and then were divided in 4 equal groups (n = 12) to receive one of the following: 5 ml saline (B); 100 mug of fentanyl (BF); 150 microg of clonidine (BC); 75 microg of clonidine and 50 microg of fentanyl (BCF). All the patients had satisfactory analgesia. Onset was similar in the 4 groups but the duration of analgesia was significantly prolonged by the addition of either 100 microg of fentanyl or 150 microg of clonidine (respectively 89.8 min and 92.5 min vs 62.5 min) (P < 0.0001). ⋯ Only patients receiving fentanyl had pruritus. Both fentanyl and clonidine produced sedation, but both incidence and severity were greater with the mixture. No differences in neonatal outcome assessed by Apgar scores and NACS, were observed.
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Int J Obstet Anesth · Jan 1995
Risk information supplied by obstetric anaesthetists in Britain and Ireland to mothers awaiting elective caesarean section.
Mothers presenting for elective caesarean section may be offered the choice of regional or general anaesthesia. Their decision requires sensible information on the risks and benefits of each technique. In order to determine the level of consensus that exists among doctors in Britain and Ireland concerning the options offered and risk information provided for such patients, a questionnaire comprising a fictitious case history and a list of sample statements was mailed to 613 members of the Obstetric Anaesthetists' Association. 523 (85.3%) replied of whom 63% would advise surgery under regional anaesthesia, 32% after full discussion would allow the mother a choice of techniques, while only 5% would advise general anaesthesia. There was broad agreement on what information should be provided, with a consensus value of 0.60 or more in 15 of 20 statements.
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Int J Obstet Anesth · Jan 1995
Bradycardia and asystole following atropine-neostigmine administration after caesarean section in a parturient receiving methyldopa for pregnancy-induced hypertension.
We report one case of bradycardia and asystole immediately after the administration of 1 mg atropine and 2 mg neostigmine after the completion of an urgent caesarean section. We attribute this adverse reaction to the treatment of pregnancy-induced hypertension with methyldopa, perhaps facilitated by other drugs employed. Similar reactions have been reported relating to beta-receptor antagonists and tricyclic antidepressants, but not to methyldopa.
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Emergent attainment of uterine relaxation is an occasional need in obstetric practice. Various agents, from amyl nitrate through volatile anesthetics have been used to relax the uterus, with varying degrees of success and side-effects. ⋯ We have used a new sublingual aerosol spray of NTG, at an initial dose of 0.8 mg, in 7 patients for rapid uterine relaxation and have not observed adverse side-effects. Prolonged shelf life, ready availability and ease of use make the sublingual spray attractive for urgent tocolysis.