International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1998
Maternal temperature during labour using low-dose (ambulatory) epidural analgesia with bupivacaine and fentanyl.
Maternal temperature is known to increase during labour with conventional epidural analgesia mixtures. To date, the effect of newer low-dose (ambulatory) epidural concentrations on maternal temperature has not been studied. Twenty-six women in established labour received epidural analgesia with 0.1% bupivacaine and 2 microg/ml fentanyl. ⋯ There was no significant overall rise in maternal temperature during labour with the use of an ambulatory epidural mixture. One patient exhibited an increase in temperature of 0.8 degrees C to 38 degrees C after 720 min and another of 1.1 degrees C to 38.1 degrees C after 630 min. We conclude that, whilst overall maternal temperature does not increase following low-dose epidural analgesia, individual increases may still occur after 10 h.
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Int J Obstet Anesth · Apr 1998
Labour analgesia in a patient with carnitine palmityl transferase deficiency and idiopathic thrombocytopenic purpura.
We report a case of a woman with carnitine palmityl deficiency (CPT) and idiopathic thrombocytopenic purpura, presenting in active labour at 38 weeks gestation. We discuss different anaesthetic factors involved with both diseases, and we propose an optimal management of such cases. Neuraxial analgesia with minimal motor blockade is indicated in early labour because it is necessary to alleviate stress in order to avoid rhabdomyolisis associated with CPT deficiency. Neuraxial analgesia is also needed because the theoretical risk of performing a caesarean section is higher than in a normal population, first because labour must be kept as short as possible and secondly because the possible thrombocytopenic in the baby precludes the use of instrumental delivery.
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Int J Obstet Anesth · Apr 1998
Epidural analgesia in labour using intermittent doses determined by midwives.
Since 1985 midwives have been responsible for choice of drug and timing of epidural top-up doses for women in labour at Flinders Medical Centre. The midwife may choose from one of three different prescribed preparations, namely: bupivacaine 12.5 mg plus pethidine 25 mg, bupivacaine 25 mg, and bupivacaine 50 mg - each made up in a volume of 10 ml. This prospective study examined the incidence of adverse effects and level of patient satisfaction with midwife-managed epidural analgesia. ⋯ Women reported a high level of satisfaction with the overall experience of childbirth, though this was lower for instrumental and caesarean deliveries than for vaginal deliveries. On the other hand, satisfaction with pain relief provided by the epidural was greater in women who had caesarean or instrumental deliveries. The most commonly cited benefits of epidurals were good pain relief (83%), ability to cope (74%), feeling relaxed (67%), and being aware (60%), while feeling numb (23%) and experiencing severe pain at delivery (17%) were the most common causes of dissatisfaction.
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Int J Obstet Anesth · Apr 1998
The use of remifentanil infusion to facilitate epidural catheter placement in a parturient: a case report with pharmacokinetic simulations.
We present a case in which remifentanil infusion was used to provide analgesia during epidural catheter placement in a parturient who was experiencing great difficulty staying motionless because of extremely painful uterine contractions. Remifentanil may provide certain advantages in this setting, including improved analgesia during the procedure, briefer residual maternal and fetal (or newborn) drug effects after the procedure, and greater technical ease of catheter placement because of decreased movement induced by pain. Pharmacokinetic simulation of the dose administered suggests that analgesic effect-site concentrations can be rapidly produced, and that these concentrations decline rapidly to clinically insignificant levels after the infusion.
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This is a retrospective record of the analgesic management during labour of 16 patients with spina bifida seen at Leicester Royal Infirmary Maternity Hospital between March 1994 and February 1996. The information highlights the potential difficulties in providing epidural analgesia for this patient group, and demonstrates how an antenatal pre-anaesthetic clinic can help to optimize pain management by providing the opportunity to formulate a realistic analgesic plan, which can be documented in the notes.