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
A comparison of informed consent for obstetric anaesthesia in the USA and the UK.
The practice of 75 UK and 75 US obstetric anaesthetists in obtaining informed consent for obstetric anaesthesia (for caesarean section) and obstetric analgesia (for labour) was compared using a postal questionnaire. The response rate was approximately 60% for each group. Of the US anaesthetists 47% obtained separate written consent for obstetric anaesthesia compared to 22% of the UK group (P=0.012). ⋯ Significantly more of the listed risks and benefits relating to general anaesthesia were discussed by the US anaesthetists compared to the UK group, median (interquartile range), 6 (4-7) and 3 (1-4), P < 0.001. There was no significant difference in discussion before regional anaesthesia but the US group discussed more information before epidural analgesia for labouring mothers obtunded by pain or drugs. These results suggest that discussion and documentation of informed consent for obstetric anaesthesia and analgesia could be improved in both countries, especially the UK.
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Int J Obstet Anesth · Jan 1995
Post partum headache after epidural analgesia without dural puncture.
In order to improve our knowledge of post partum headache, during a two-year period we studied a large population of pregnant patients of our institution using a four-stage process including two questionnaires (the first at 12-15 weeks' gestation and the second in the first week after delivery), a pre-anesthetic visit at 36 +/- 2 weeks' gestation and a computer printout obtained at delivery. Of 1058 patients for whom records were complete and who had epidural analgesia during labor not complicated by dural puncture, 128 (12.1%) complained of post partum headache. ⋯ Data from the medical history or from the current pregnancy as well as data obtained during delivery (maternal and fetal-neonatal) were not significantly different between those patients free of pain and those presenting with headache, except for a history of migraine and pregnancy-induced hypertension which were both associated with an increased risk of post partum headache. These risk factors should be considered in both clinical studies and obstetric malpractice claims.
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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
Backache and epidural analgesia: a retrospective survey of mothers 1 year after childbirth.
A questionnaire was sent to 2065 mothers 1 year after delivery as part of a larger study into patient satisfaction with all aspects of their obstetric care. The response rate adjusted for non-delivered mail was 67.1%. There was a high incidence of new long-term backache in mothers who had received epidural analgesia (26.2% at one year) compared to the mothers who had not (1.7%). Further analysis of the data revealed no other significant associated factor.