International journal of obstetric anesthesia
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Although hypothermia has been reported during epidural anesthesia performed for nonobstetrical surgery or cesarean section, epidural analgesia for labor may lead to hyperthermia. Its incidence, time-course and intensity are influenced by multiple factors including site of measurement, duration of labor preceding epidural analgesia and perhaps ambient temperature and occurrence of shivering. During the first 2-5 h of epidural analgesia, a significant increase in temperature is not usually observed. ⋯ However, fetal tachycardia may occur and the potential for a deleterious effect on the fetus remains controversial. Various measures for cooling the mother have been proposed but their efficacy has not been evaluated. The recognition that epidural analgesia may provoke hyperthermia may help to avoid inappropriate use of antibiotics or fetal extraction.
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Three cases of transient osteoporosis of the hip in pregnancy are reported, and the implications of this rare condition for anaesthetists are considered.
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Int J Obstet Anesth · Jan 1997
Hamman's syndrome: pneumomediastinum and subcutaneous emphysema occurring in labour.
The syndrome of pneumomediastinum and subcutaneous emphysema is a rare and interesting complication of labour. The first case was recorded in 1784 and since that time some 200 other cases have been published. However, very little has appeared in the anaesthetic journals. ⋯ Chest X-ray showed a pneumomediastinum. It is postulated that the use of nitrous oxide may have exacerbated and so highlighted a pre-existing pneumomediastinum since there were no other features of the anaesthetic to account for this pathology. The pathophysiology, diagnosis and management of this condition are discussed together with a historical literature review.
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Int J Obstet Anesth · Jan 1997
Clinical Trial Controlled Clinical TrialPerioperative analgesia for caesarean section: comparison of intrathecal morphine and fentanyl alone or in combination.
In a double-blind placebo-controlled trial we compared perioperative pain relief using different intrathecal opioid regimens given with bupivacaine during spinal anaesthesia for elective caesarean section. One hundred and sixteen patients undergoing elective caesarean section were divided into four groups (A, B, C, D) of 29 patients each. In addition to hyperbaric bupivacaine (12-14 mg), group A received 1 ml of normal saline, group B 25 microg of fentanyl, group C 100 microg of morphine, and group D received both fentanyl 25 microg and morphine 100 microg intrathecally. ⋯ The use of the opioids in association, however, was found to increase the incidence of side-effects. The quality of postoperative analgesia with fentanyl, when used alone, was found to be inferior to that with morphine. The combination of opioids offered no advantage over morphine alone.