International journal of obstetric anesthesia
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In May 2005 the Obstetric Anaesthetists' Association (OAA) and Association of Anaesthetists of Great Britain and Ireland published a document entitled Guidelines for Obstetric Anaesthetic Services. This survey investigated if standards recommended in this document were being met more than six months after its release. ⋯ This national survey illustrates to what extent UK departments meet national guidelines for provision of obstetric anaesthesia services. It also highlights areas for improvement nationally and could be used by individual units to plan resources in the future.
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Int J Obstet Anesth · Oct 2008
Randomized Controlled TrialLow-dose ropivacaine-sufentanil spinal anaesthesia for caesarean delivery: a randomised trial.
It is well known that intrathecal opioids have a synergic effect with spinal local anaesthetics. The aim of this study was to evaluate whether low-dose ropivacaine in combination with sufentanil could produce effective spinal anaesthesia with less maternal hypotension and vomiting than ropivacaine alone. ⋯ The combination of hyperbaric ropivacaine 10 mg with sufentanil 5 lg produced effective spinal anaesthesia for caesarean delivery with significantly less hypotension, vomiting and shivering, shorter duration of motor blockade and longer lasting analgesia than hyperbaric ropivacaine 15 mg.
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Int J Obstet Anesth · Oct 2008
A retrospective case-controlled study of the association between request to discontinue second stage labor epidural analgesia and risk of instrumental vaginal delivery.
Epidural dose is often reduced in the second stage of labor with the intention of improving maternal expulsive efforts and decreasing the need for instrumental vaginal delivery (IVD). We conjectured that parturients requiring IVD would have had more analgesic interventions and requests to decrease analgesic density in the second stage. ⋯ These results support an association between a request to reduce epidural dose in the second stage of labor, as well as supplemental analgesia for treatment of breakthrough pain, with IVD. It is unclear whether administration of more local anesthetic to treat breakthrough pain results in more dense motor blockade, and hence increases risk of IVD, or whether the decrease in infusion rate reflects obstetricians' dissatisfaction with the progress of obstructed labor.
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Int J Obstet Anesth · Oct 2008
Case ReportsAnaesthesia for caesarean section in a patient with Ehlers-Danlos syndrome associated with postural orthostatic tachycardia syndrome.
We report the use of regional anaesthesia for elective caesarean section in a primigravida with hypermobility type Ehlers-Danlos syndrome (type III) associated with postural orthostatic tachycardia syndrome. Single-shot spinal anaesthesia was performed after failed epidural anaesthesia. This genotype, although generally associated with fewer antenatal and peripartum complications, is more likely than other types to display dysautonomia and orthostatic intolerance. This requires careful management for delivery.