International journal of obstetric anesthesia
-
Int J Obstet Anesth · Jul 2002
Randomized Controlled Trial Clinical TrialHaemodynamic changes caused by oxytocin during caesarean section under spinal anaesthesia.
The haemodynamic effects of oxytocin receive scant attention in pharmacology texts, but may be clinically significant in vulnerable patients. Despite prescriber information recommending a dose of 5 international units by slow i.v. injection, it is the authors' experience that it is very common practice in the UK to give 10 units as a rapid injection. We therefore conducted a randomised, double-blind study of the haemodynamic changes induced by rapid bolus of 5 or 10 units of oxytocin in 34 healthy term parturients at caesarean section under spinal anaesthesia. ⋯ This has been illustrated by a maternal death reported to the Confidential Enquiries into Maternal Deaths in the United Kingdom. The need to adhere to a dose regimen of 5 units by slow injection needs re-emphasis, but no evidence exists to claim that even this will be haemodynamically inert. We therefore recommend that oxytocin boluses be avoided in women with hypovolaemia or cardiac disease.
-
Int J Obstet Anesth · Jul 2002
Randomized Controlled Trial Clinical TrialA comparative study of three different doses of 0.5% hyperbaric bupivacaine for spinal anaesthesia in elective caesarean section.
We conducted a double-blind comparison of three doses (7.5 mg, 8.75 mg and 10 mg) of 0.5% hyperbaric bupivacaine in women undergoing elective caesarean under spinal anaesthesia. Sixty women were randomised into 3 groups of 20. Group A received 7.5 mg, group B 8.75 mg and C 10 mg of study drug. ⋯ The incidence of hypotension was greater in groups B and C than in group A (P < 0.05). Group C women had a greater incidence of bradycardia than did groups A and B (P < 0.05). The 7.5-mg dose of 0.5% hyperbaric bupivacaine was observed to provide acceptable analgesia without any significant incidence of adverse effects such as maternal hypotension or bradycardia.
-
Int J Obstet Anesth · Jul 2002
Randomized Controlled Trial Clinical TrialCombined spinal epidural anaesthesia for caesarean section: a randomised comparison of Oxford, lateral and sitting positions.
Maternal position during induction of intrathecal anaesthesia for caesarean section influences block height and haemodynamic stability. In a randomised study of 90 women presenting for elective caesarean section using combined spinal-epidural anaesthesia, three positions were compared--the Oxford position (group O), the right lateral to supine wedged (group R) and the sitting to supine wedged (group S). Hyperbaric bupivacaine 12.5 mg with fentanyl 12.5 microg was injected intrathecally using a needle-through-needle CSE technique. ⋯ There were no significant differences in blood pressure although ephedrine requirements were less in group R. There were no significant differences in the incidence of maternal nausea and vomiting or in neonatal outcome as assessed by Apgar scores and umbilical cord blood gas analysis. Although the study failed to show any significant differences in block height between the groups, no women in group O had a block above T2 compared with three in group R and three in group S.
-
Int J Obstet Anesth · Jul 2002
The effect of epidural analgesia on postpartum urinary retention in women who deliver vaginally.
There have been several investigations reporting on urinary retention in postpartum women who delivered vaginally with epidural blockade. The mechanism and incidence of urinary retention in relation to epidural analgesia, however, are not established. The objectives of this study were to investigate the association between various obstetric parameters and urinary retention and to determine whether those women with postpartum urinary retention subsequently develop urinary problems. ⋯ Epidural analgesia provides valuable pain relief but may be associated with greater residual urine. Postpartum urinary retention is, however, more related to prolonged labor than to the effect of epidural analgesia itself. Close monitoring of the progress of labor and avoiding urine retention are essential.
-
Substance abuse, including that of cocaine, has crossed social, economic and geographic borders and remains one of the major problems facing society today. The prevalence of cocaine abuse in young adults (including women) has increased markedly over the past two decades. ⋯ The diverse clinical manifestations of cocaine abuse combined with physiologic changes of pregnancy, and pathophysiology of coexisting pregnancy-related disease might lead to life-threatening complications and significantly impact the practice of obstetric anesthesia. A complete understanding of the physiology of pregnancy, pathophysiology of pregnancy-specific disorders and anesthetic implications of cocaine abuse in pregnancy is essential to tailor a safe anesthetic plan for this high-risk group of patients.