International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 1996
Comparison of 15 mg and 25 mg of bupivacaine both with 50 microg fentanyl as initial dose for epidural analgesia.
Bupivacaine 15 mg is commonly used as a test dose prior to the initial dose for epidural analgesia in labour. When 15 mg or 25 mg of bupivacaine (15 ml of 0.1% or 0.167%) with 50 microg fentanyl was administered blindly to two groups of labouring women, as an initial dose, 83% and 90% of women respectively, achieved analgesia within 20 min. All the remaining women achieved analgesia with a further dose of 10 mg bupivacaine (10 m10.1%) with fentanyl 2 microg per ml given at 20 min.
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Int J Obstet Anesth · Oct 1996
The anaesthetic management of a labouring woman with pulmonary arterio-venous malformations.
Epidural analgesia is recommended for many medical conditions in labouring women. We describe a case where it was used successfully in a parturient with multiple pulmonary arterio-venous (a-v) malformations. It has been noted that pregnancy can cause marked deterioration in the condition of such patients. We support the suggestion that pulmonary a-v malformations can be added to the list of conditions for which epidural analgesia should be considered.
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Intravenous nitroglycerin was used to provide uterine relaxation for cesarean delivery of a macrosomic infant. The procedure was complicated by uterine inversion, and subsequent uterine atony. While several other factors may have contributed to the uterine atony, nitroglycerin administration might have played a role. Further, while nitroglycerin was helpful in facilitating the delivery of the macrosomic infant, the risk of uterine inversion must be considered.
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Int J Obstet Anesth · Oct 1996
Untoward incident reporting in obstetric anaesthesia: a 6-month prospective study in Northern Ireland.
The marked reduction in the number of cases related to the provision of anaesthesia, included in the triennial Reports on Confidential Enquiries into Maternal Deaths in the UK, may limit the educational value of such reports for anaesthetists in the future. The collection, analysis and reporting of untoward events related to obstetric anaesthesia may provide an additional method of highlighting areas of clinical practice that could be improved. ⋯ A brief summary of each event is included along with a more detailed description from a sample of the reports. The advantages and disadvantages of untoward incident reporting are discussed, with recommendations made for a future survey.