International journal of obstetric anesthesia
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We wished to determine whether immunosuppression and/or acceleration of human immunodeficiency virus (HIV)-associated disease is related to the mode of anesthesia in the HIV infected parturient. Ninety-six known HIV-infected asymptomatic parturients who delivered between January 1990 and January 1992 at Grady Memorial Hospital were reviewed for pre-delivery health status, mode of anesthesia and peripartum/post-partum complications. Statistics used chi2 analysis. ⋯ Thirty-one of the 96 women had CD4/CD8 T-cell lymphocyte data at second trimester and 24-48 h post partum which showed no worsening of maternal immune status in women receiving regional anesthesia, local anesthesia/intravenous sedation or no anesthesia. We believe that both regional and general anesthesia can be performed safely on the asymptomatic HIV-infected parturient. The choice of anesthesia should be based on the usual obstetric and clinical considerations.
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Int J Obstet Anesth · Apr 1997
Randomized Controlled Trial Clinical TrialAnalgesia after caesarean section: patient-controlled intravenous morphine vs epidural morphine.
In a randomized, double-blind study, conducted in 60 patients after caesarean section, we compared epidural morphine (5 mg) with intravenous morphine patient-controlled analgesia (PCA). Efficacy of pain relief (visual analogue scale), comfort, satisfaction and side-effects were studied. In the PCA group, pain scores were higher (P < 0.005) from the third hour onward. ⋯ Consumption of morphine was higher in the PCA group. We conclude that epidural morphine analgesia, though of good quality, was associated with more pruritus. Morphine PCA, although producing a lesser degree of analgesia compared to epidural morphine, gave good satisfaction.
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Int J Obstet Anesth · Apr 1997
Anatomy of the lumbar epidural region using magnetic resonance imaging: a study of dimensions and a comparison of two postures.
Many techniques used to investigate the epidural region may alter the anatomy. Magnetic resonance imaging (MRI) has been introduced as a non-invasive diagnostic technique. The aim of this study was to investigate the anatomy of the lumbar epidural region using MRI, studying the morphology, the dimensions and the modification that may result from a change of position. ⋯ The circumferentially and metamerically segmented compartments of the epidural space were clearly noted and measured. Ligamenta flava seem to be thinner in younger than in older subjects. This may partly explain a reduced loss of resistance sometimes perceived in obstetric patients.