International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2004
Comment Letter Comparative StudyEphedrine or phenylephrine to prevent or treat hypotension during spinal anaesthesia for caesarean section.
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Int J Obstet Anesth · Jul 2004
Comparative StudyA comparison of cold, pinprick and touch for assessing the level of spinal block at caesarean section.
The sensory block levels of 102 women undergoing caesarean section under spinal anaesthesia were assessed by four different methods: sharp pinprick (Neurotip tester pin), cold (ethyl chloride spray), touch (Neurotip tester pin), touch (ethyl chloride spray). While the data indicate a median difference of some 2 segments between the levels of block assessed by sharp pinprick or cold, and touch, there was no constant relationship between these levels of block within the group nor within individual patients: variable and at times very large differences in the levels of block assessed among these modalities existed: up to 10 segments (pinprick - touch); 11 segments (cold - touch). ⋯ The results suggest that, for clinical purposes, there is no difference in outcomes whether Neurotip touch or ethyl chloride spray touch sensations are used. When using diamorphine 100 micrograms/mL mixed with bupivacaine 0.5% w/v in 8% dextrose, no patient felt any pain or discomfort provided the block to Neurotip or ethyl chloride touch sensations included T6 or above.
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Int J Obstet Anesth · Jul 2004
Case ReportsManagement of a parturient with paroxysmal nocturnal haemoglobinuria.
We present the case of a 30-year-old parturient diagnosed in the first trimester of her first pregnancy as having paroxysmal nocturnal haemoglobinuria. Pancytopenia necessitated regular transfusion of blood products. The risks of infection, haemorrhage and thrombosis, in the presence of severe thrombocytopenia, mild neutropenia and prophylactic anticoagulation, posed management challenges. ⋯ Severe thrombocytopenia proved a contraindication to regional techniques and she required general anaesthesia for evacuation of a retained placenta. The post-partum period was complicated by fever and a requirement for blood products. Management of these problems, of prophylactic anticoagulation and subsequent therapy, are discussed.
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Int J Obstet Anesth · Jul 2004
Demographic differences between consenters and non-consenters in an obstetric anesthesiology clinical study.
Willingness to participate in obstetric anesthesiology clinical studies may be influenced by age, parity or ethnicity. This study was designed to determine whether there were demographic differences between consenters and non-consenters in a minimum local analgesic concentration clinical study. Four hundred and fifty-two women were approached for the study and the age, ethnicity and parity of patients who consented or declined to participate were collected. ⋯ Black Americans were more likely to consent than Asian Americans (P<0.001) and as likely to consent as white Americans. There were no statistically significant differences in the consent rate between Caucasian and Asian Americans. More studies are needed to determine the socioeconomic and demographic factors that affect consent rates of labor patients.