International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2004
Randomized Controlled Trial Clinical TrialHip-flexed postures do not affect local anaesthetic spread following induction of epidural analgesia for labour.
Hip-flexed postures enlarging the pelvic diameter are used to improve the obstetric course of labour. Although most investigations show that lateral and sitting positions do not affect the spread of epidural analgesia, the effect of recently introduced hip-flexed postures has yet to be confirmed. This prospective randomised study included 93 parturients. ⋯ There was no motor block nor any maternal or fetal side effects. The power of the study (1 - beta) was 93%. We conclude that, for the three hip-flexed postures tested, position does not influence local anaesthetic spread or symmetry of thermo-algesic blockade after induction of obstetric epidural analgesia.
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Int J Obstet Anesth · Apr 2004
Case ReportsVery low-dose spinal anesthesia for cesarean section in a morbidly obese preeclamptic patient and its potential implications.
To our knowledge, based on a literature search, this is the first case report of successful cesarean section requiring a very low total dose of 5 mg hyperbaric spinal bupivacaine without any spinal or intravenous supplements in a morbidly obese (BMI=66 kg/m(2)) preeclamptic parturient. This parturient appeared to be more sensitive than the average to spinal anesthesia for cesarean section. ⋯ This report does not suggest the routine use of low-dose spinal anesthesia without supplements, but illustrates the wide variability in dosage and sensitivity to spinal anesthetics, and suggests that further research is needed in this area, particularly in morbidly obese parturients. Furthermore, it emphasizes the importance of vigilance and frequent blood pressure and respiration monitoring even in cases of low-dose spinal analgesia, such as that used in the combined spinal-epidural technique for labor analgesia.
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We conducted a retrospective review of obstetric patients admitted to the intensive care unit at Al-Ain hospital during period January 1(st) 1997 to December 31(st) 2002, in order to identify the indications for admission and the outcome. A total of 60 patients were admitted during the six years. The frequency of admission was 2.6 per 1000 deliveries and obstetric patients represented 2.4% of all ICU admissions. ⋯ The mean APACHE II score and duration of stay were significantly higher in these patients. There were two deaths, representing 3.3% of obstetric intensive care unit admissions. Our findings highlight the need for establishing a high dependency unit to avoid unnecessary admission to the intensive care unit and to ensure proper management.