International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2007
Randomized Controlled TrialLocal infiltration of epinephrine-containing lidocaine with bicarbonate reduces superficial bleeding and pain during labor epidural catheter insertion: a randomized trial.
Superficial bleeding after labor epidural catheter placement is a common phenomenon. In addition to delaying securing the epidural catheter, it may loosen the adhesive catheter dressing. The primary aim of this study was to determine whether skin infiltration with epinephrine-containing rather than plain lidocaine reduces superficial bleeding after catheter placement. Secondary objectives were to determine whether adding epinephrine and/or sodium bicarbonate affected infiltration pain. ⋯ Local infiltration of epinephrine-containing lidocaine before epidural catheter insertion reduces superficial bleeding and the addition of bicarbonate decreases pain during skin infiltration.
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Int J Obstet Anesth · Apr 2007
Randomized Controlled TrialPrediction of hypotension during spinal anesthesia for Cesarean section and its relation to the effect of crystalloid or colloid preload.
If parturients prone to develop caval compression in the supine position were identified before delivery, this might be a method of predicting hypotension during caesarean section under spinal anesthesia. Colloid preloading is superior to crystalloid in reducing the risk for spinal anesthetic-induced hypotension. It is postulated that parturients preoperatively susceptible to the supine position would benefit the most from colloid preloading. ⋯ Pregnant women with a positive preoperative supine stress test constitute a subset at increased risk for clinically significant hypotension during cesarean delivery under spinal anesthesia. These women seem more likely to benefit from prophylactic colloid solution than women with a negative stress test.
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Int J Obstet Anesth · Apr 2007
Case ReportsDelayed diagnosis of posterior reversible encephalopathy syndrome (PRES) in a parturient with preeclampsia after inadvertent dural puncture.
Posterior reversible encephalopathy syndrome is a rare complication generally associated with headache and acute changes in blood pressure. We present a case of posterior reversible encephalopathy syndrome where diagnosis was delayed because the patient also had preeclampsia and an inadvertent dural puncture, both associated with headache. The clinical challenge and the need for prompt diagnosis and treatment are emphasized.
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Int J Obstet Anesth · Apr 2007
Case ReportsTrigeminal nerve palsy and Horner's syndrome following epidural analgesia for labor: a subdural block?
Horner's syndrome is a rare complication of epidural analgesia for labor. Much more uncommon is trigeminal nerve palsy. Both complications may be attributed to a subdural localization of the catheter, as we demonstrated clinically by a repeat injection and patchy sympathetic block and with the typical image on epidurography.
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Int J Obstet Anesth · Apr 2007
Case ReportsAnaesthesia for Caesarean section in a patient with diastrophic dwarfism.
Diastrophic dwarfism is a rare disease in which pregnancy is uncommon. In this report we present a woman with diastrophic dwarfism who underwent caesarean section under epidural anaesthesia. Her care was successfully managed with multidisciplinary team planning. The total dose of local anaesthetic needed for epidural block was greater than the doses reported for achondroplastic dwarfism.