International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1999
Randomized Controlled Trial Clinical TrialPain during elective caesarean section under epidural anaesthesia: the effect of a 10 degrees head-up tilt position.
One hundred patients scheduled for elective caesarean section under epidural anaesthesia were randomized to have epidural loading doses in either the horizontal or a 10 degrees head-up position. They were assigned to their position only after an initial dose of 4 ml of 0.5% bupivacaine had been given. Ten minutes after this dose they were given 10 ml of 0.5% bupivacaine and 50 microg of fentanyl in their allocated position. ⋯ The inter-quartile range was 0 to 2 for the head-up tilt position and 0 to 4 for the horizontal position (P<0.05). Position had no significant effect on the blood pressure or Bromage score. A 10 degrees head-up tilt position is useful during the establishment of epidural anaesthesia to reduce the pain experienced by the patient during caesarean section.
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Int J Obstet Anesth · Apr 1999
Cell salvage in obstetrics: an evaluation of the ability of cell salvage combined with leucocyte depletion filtration to remove amniotic fluid from operative blood loss at caesarean section.
During 27 elective caesarean sections, operative blood loss was collected and processed using the Haemonetics Cell Saver 5 and filtered by Pall RC 100 leucocyte depletion filtration. The efficiency of removal of amniotic fluid, and the degree. of contamination with fetal red cells were assessed in the resulting 'cleaned' blood. Cell saver processing effectively removed alpha-fetoprotein from the red cells of 14 patients whose amniotic fluid was removed by separate suction and from nine of the 13 patients whose amniotic fluid was aspirated into the cell saver along with operative blood loss. ⋯ Had this been re-transfused into a rhesus-incompatible mother it would have required 2500 i.u. (500 microg) anti-D immunoglobulin to prevent rhesus-immunization of the mother. Contamination of processed caesarean section blood with fetal red cells and fetal squames is defined and its clinical implications discussed, with an overview of the development and current status of cell salvage. Autotransfusion by cell salvage with leucocyte depletion filtration should be considered in life-threatening obstetric haemorrhage and offered to Jehovah's Witnesses.
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Int J Obstet Anesth · Apr 1999
Awake fibreoptic intubation, airway compression and lung collapse in a parturient: anaesthetic and intensive care management.
A 28-year-old primigravida at 35 weeks gestation with acute onset of dyspnoea and stridor due to an intrathoracic neoplasm required semi-urgent caesarean section to allow diagnosis and treatment. Her inability to lie supine precluded regional anaesthesia. She underwent awake fibreoptic oral intubation followed by general anaesthesia. This was complicated by desaturation, high airway pressures, unilateral lung collapse, venous congestion and unexpected blood loss due to an undiagnosed placenta praevia.
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Angioneurotic oedema is a rare disease caused by Cl esterase inhibitor deficiency. Hereditary angioneurotic oedema includes type I (quantitative and functional) deficiency and type 11 (functional) deficiency. Its prophylactic treatment during pregnancy, based on danazol therapy if the fetus is male, may avoid acute attacks of generalized or laryngeal oedema. ⋯ Regional analgesia is indicated for labour or caesarean section to prevent pain and stress and to avoid the difficulties associated with laryngeal oedema and tracheal intubation. In the treatment of an acute attack, Cl esterase inhibitor concentrates (1500 units) may be given i.v. We present two cases, one of hereditary and one of acquired angioneurotic oedema, both presenting during pregnancy and both delivered vaginally under epidural analgesia with successful outcome.