International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2007
Randomized Controlled Trial Comparative StudyA randomised comparison of a hand-held Neurotip and the Neuropen for assessing loss of touch sensation during spinal anaesthesia for caesarean section.
With spinal anaesthesia various methods may be used to assess the block to touch. We wished to compare the levels of block assessed using a non-standardised, assessor-dependent touch stimulus with those assessed when the same stimulus was applied in a standardised manner independent of the assessor. ⋯ When comparing two very similar touch stimuli, one standardised and user-independent and one non-standardised, we observed occasional wide but short lived differences in the assessed levels of block to touch. Although these differences did not affect clinical management, whether more dissimilar touch testing methods might affect clinical management remains to be seen.
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Int J Obstet Anesth · Jul 2007
Randomized Controlled TrialEfficacy of patient-controlled epidural analgesia after initiation with epidural or combined spinal-epidural analgesia.
The aim of the present study was to compare the efficacy of patient-controlled epidural analgesia after initiation with either epidural or combined spinal-epidural analgesia. ⋯ Both regional analgesia techniques followed by demand-only PCEA provided efficient pain relief for labor without changing the duration of labor or rate of cesarean section.
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Int J Obstet Anesth · Jul 2007
Case ReportsAspergillus meningitis following spinal anaesthesia for caesarean section in Colombo, Sri Lanka.
We report six cases of Aspergillus meningitis after spinal anaesthesia for caesarean section administered in June and July 2005. Three patients died before a fungal infection was confirmed at the first post-mortem examination in August. ⋯ Some syringes and spinal needles supplied to the hospitals concerned were found to be contaminated with Aspergillus fumigatus. Investigators found that medical supply storage facilities were substandard following the influx of donations after the tsunami of December 2004.
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Intrathecal anaesthesia, either as a single shot-spinal or as part of a combined spinal-epidural technique, is now widely accepted as the management of choice for caesarean section. It generally produces rapid and predictable anaesthesia, yet occasionally fails for no apparent reason. Four case reports of seemingly inexplicable complete failure of intrathecal anaesthesia are presented, together with a literature review of other cases and possible causes of the failure, which include anatomical abnormality, drug failure and management failure.