International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1998
Complications of obstetric epidural analgesia and anaesthesia: a prospective analysis of 10,995 cases.
Although epidural anaesthesia and analgesia are widely used in obstetrics, there are no large contemporary prospective series detailing associated complications. Prospective data was collected on all obstetric epidural blocks performed for labour and delivery in a single institution between July 1989 and August 1994. A data entry sheet was compiled and entered onto a computer database. ⋯ There was no major local anaesthetic toxicity or neurological deficit. The incidence of potentially life-threatening morbidity was thus 0.02% although in both cases outcome was good. The only persisting complication was neurological, an apparent epidural catheter-induced traumatic mononeuropathy.
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Int J Obstet Anesth · Jan 1998
Mivacurium for caesarean section in hypertensive parturients receiving magnesium sulphate therapy.
The interaction between mivacurium and magnesium sulphate was investigated in a group of parturients undergoing caesarean section under general anaesthesia. Thirty parturients were studied; 10 normotensive controls (group NT), 10 hypertensive controls (group HT) and 10 hypertensives who received magnesium sulphate (group HTM). At induction group HT received 30 microg/kg of alfentanil and group HTM 10 microg/kg of alfentanil and 30 or 60 mg/kg of magnesium sulphate. ⋯ Time to maximal recovery, and time from 25-75% of maximal recovery from mivacurium, were significantly prolonged in group HTM (60.9 +/- 15.3 min and 16.8 +/- 5.6 min) compared with group HT (34.9 +/- 7.6 min and 7.6 +/- 3.6 min) and group NT (37.4 +/- 14.4 min and 8.5 +/- 3.4 min) (P < 0.01). Time to 25% recovery was prolonged in group HTM (35.1 +/- 7.4 min) compared with the other two groups (HT: 21.6 +/- 6.4 min and NT: 22.8 +/- 10.2 min) (P < 0.01). Whilst the duration of action of mivacurium, determined by electromyography, is prolonged by subtherapeutic serum magnesium concentrations, of the available non-depolarizing relaxants mivacurium would seem to be most appropriate for caesarean section.
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Int J Obstet Anesth · Jan 1998
Randomized Controlled Trial Clinical TrialAnaesthesia for caesarean delivery: low-dose epidural bupivacaine plus fentanyl.
To determine the acceptability of epidural bupivacaine-induced sixth thoracic (T6) sensory blockade and the analgesic efficacy of epidural fentanyl 50 microg, 24 parturients undergoing elective caesarean section were given a test dose of lidocaine 60 mg plus epinephrine followed by 10 ml of either 0.5 % bupivacaine (control group) or 0.5 % bupivacaine plus 50 microg fentanyl (fentanyl group) in a randomized double-blind manner. Fifteen minutes later loss of pinprick sensation was determined. Additional local anaesthetic was titrated to achieve T6 sensory blockade. ⋯ The incidence of side-effects was unaffected by treatment group. Apgar scores were similar in the two groups. We conclude that following administration of 10-15 ml 0.5% bupivacaine plus fentanyl 50 microg, T6 sensory blockade is associated with good intraoperative analgesia without obvious maternal or neonatal respiratory depression.
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Int J Obstet Anesth · Jan 1998
Anaesthetic management of a parturient with severe congenital factor XI deficiency undergoing caesarean section for triplet pregnancy.
The report describes the anaesthetic management of a Jewish patient of Ashkenazi descent with severe factor XI deficiency complicated by thrombocytopenia for caesarean section for triplets at the 35th week of gestation. Perioperative management consisted of sustained replacement therapy with fresh frozen plasma and platelets until the sixth postoperative day. General anaesthesia was used for the procedure. No other maternal or neonatal complications occurred.
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During pregnancy, the thyroid undergoes several changes including altered function and gland enlargement. We describe the management of a 38-week pregnant woman presenting with cough and increasing breathlessness. She gave a 5-year history of asthma which initially obscured the final diagnosis of upper-airway obstruction secondary to tracheal compression by a large retrosternal goitre. ⋯ Delivery by caesarean section was carried out under epidural anaesthesia, following which her symptoms rapidly resolved. A subtotal thyroidectomy was performed 4 weeks later under general anaesthesia, again without incident. We outline the normal physiological changes that occur to the thyroid gland during pregnancy and also highlight the value of the flow volume loop in the evaluation of airway obstruction.