International journal of obstetric anesthesia
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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.
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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.
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Int J Obstet Anesth · Jul 2002
Trends in obstetric anaesthesia and analgesia over a ten year period in the University Malaya Medical Centre, Kuala Lumpur.
Available data for obstetric care in the University Malaya Medical Centre, Kuala Lumpur from 1987 to 1999 were reviewed. Despite incomplete data, we were able to determine fairly well the practice of obstetric anaesthesia and analgesia in the unit, and the changes over the years. ⋯ By 1999, regional anaesthesia had become the most common method of anaesthesia administered in both elective (14.3% epidural and 63.5% spinal) and emergency (30.2% epidural and 42.6% spinal) caesarean sections. The percentage of patients delivering vaginally who received epidural analgesia appeared to have stabilised at about 8 to 9% in the last few years, with a gradual decline in the total instrumental delivery rate from a high of about 12% to the pre-epidural rate of 7%.
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It has always been recognised that the practice of medicine requires an ethical base. This ethical base also provides a backbone for a legal framework. Until recently paternalism was the accepted norm in the physician-patient relationship. ⋯ Whether labouring women have capacity is discussed. There are times when patients are not able to act autonomously and the roles of advance directives (which can include birth plans) and substitute decision makers become important. The application of ethical practice to research in obstetric anaesthesia is considered.
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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.