International journal of obstetric anesthesia
-
Int J Obstet Anesth · Apr 2006
Randomized Controlled Trial Comparative StudyA randomised comparison of 0.5% bupivacaine with a lidocaine/epinephrine/fentanyl mixture for epidural top-up for emergency caesarean section after "low dose" epidural for labour.
When extending a fentanyl-containing, low-dose labour epidural for emergency caesarean section it has been shown that there is no difference in time to surgical readiness between plain bupivacaine 0.5% and mixtures of lidocaine/epinephrine or lidocaine/bupivacaine/epinephrine. However, it is not known whether adding fentanyl to the lidocaine/epinephrine mixture would increase speed of onset or improve the efficacy of the mixture when topping up for an emergency caesarean section. ⋯ The use of a lidocaine/epinephrine/fentanyl mixture conferred no clear statistically significant benefit over the use of plain 0.5% bupivacaine when used to extend fentanyl containing low-dose labour epidural analgesia for emergency caesarean section, but the lidocaine solution is cheaper and less toxic than the alternatives.
-
Int J Obstet Anesth · Apr 2006
ReviewPractical management of the parturient with congenital heart disease.
Cardiac disease is becoming more common in women presenting for maternity care and is a major cause of maternal mortality in the UK. We present a review of the management of parturients with congenital heart disease, focusing on practical aspects and the problems that may be expected.
-
Int J Obstet Anesth · Apr 2006
Case ReportsOn knots in epidural catheters: a case report and a review of the literature.
A lumbar epidural catheter placed for labor analgesia proved to be difficult to remove after an uneventful delivery. With the patient in the position of catheter insertion, i.e. seated, firm and steady traction allowed removal of the catheter and revealed a knot 4 mm from its tip. Passing excessive amount of catheter into the epidural space may have contributed to this complication. Guidelines to prevent and to minimize this complication are suggested.
-
Int J Obstet Anesth · Apr 2006
Obstetric regional blocks for women with multiple sclerosis: a survey of UK experience.
There has been a reluctance to use regional blocks for women with multiple sclerosis as effects on the course of the disease are unclear. We assessed the views of UK consultant obstetric anaesthetists regarding management of women with multiple sclerosis. ⋯ Most UK anaesthetists would perform regional blocks for labour and caesarean section in multiple sclerosis, although the experience of each anaesthetist is limited. Many emphasised the need for thorough pre-assessment and informed consent.