International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1998
Randomized Controlled Trial Clinical TrialVolume preload: lack of effect in the prevention of spinal-induced hypotension at caesarean section.
A randomized double-blind study of 40 women was performed to compare blood pressure changes between two groups of women following induction of spinal anaesthesia for elective caesarean section. One group received a 1 L Ringer's solution preload, administered over 10 min, before spinal anaesthesia while the other group received no preload. ⋯ There were no differences between the groups in terms of neonatal outcome as assessed by Apgar score, umbilical arterial and venous blood pH, and Neonatal Adaptive Capacity Scores. When ephedrine is infused prophylactically immediately following spinal anaesthesia for elective caesarean section, a 1000 ml crystalloid preload confers no advantages in terms of maternal blood pressure control or neonatal outcome.
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Int J Obstet Anesth · Apr 1998
Randomized Controlled Trial Clinical TrialAnalgesia produced by epidural diamorphine is better following caesarean section under spinal anaesthesia than under epidural anaesthesia.
In a randomized double-blind study, the efficacy, duration of action and side-effects of epidural diamorphine 2.5 mg in 10 ml normal saline were compared following elective caesarean section under either spinal anaesthesia (using a combined spinal epidural technique, n = 32) or conventional epidural anaesthesia (n = 26). Median visual analogue pain scores were consistently lower in patients who had received spinal anaesthesia and this reached significance at 24 h (P = 0.02). ⋯ The incidence of side-effects was similar in the two groups. The improved analgesia following spinal anaesthesia is another advantage of the combined spinal epidural technique over conventional epidural anaesthesia for elective caesarean section.
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Int J Obstet Anesth · Apr 1998
Randomized Controlled Trial Clinical TrialMaternal, fetal and placental distribution of lidocaine-epinephrine and bupivacaine after epidural administration for cesarean section.
Bupivacaine and lidocaine are both lipophilic drugs, bupivacaine being more lipophilic and protein-bound. Our earlier studies, using human placenta perfused in vitro, showed that increased placental binding of bupivacaine restricts fetal transfer compared to the higher fetal transfer of lidocaine. However, placental tissue concentrations of local anesthetics have not been determined in the clinical context. ⋯ Values for area under the concentration-time curves per unit of dose were similar. In conclusion, maternal plasma concentrations, fetal/maternal concentration ratios and placental tissue binding of lidocaine resembled those of bupivacaine after epidural administration. These findings are probably explainable by the effect of maternal hypotension on the distribution of lidocaine.
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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.