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
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 Reports Multicenter StudyA prospective study of awareness and recall associated with general anaesthesia for caesarean section.
The obstetric population is considered at high risk of awareness and recall when undergoing general anaesthesia for caesarean section. In recent years the incidence may have been altered by developments in obstetric anaesthesia. ⋯ Awareness with recall of intraoperative events remains a significant complication of obstetric general anaesthesia but was potentially avoidable in all cases detected in this study.
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Int J Obstet Anesth · Oct 2008
Randomized Controlled Trial Comparative StudyImpact of the addition of sufentanil 5 microg or clonidine 75 microg on the minimum local analgesic concentration of ropivacaine for epidural analgesia in labour: a randomized comparison.
Addition of lipophilic opioids or alpha2-agonists to local anaesthetic solutions reduces local anaesthetic requirements and side effects. While the efficacy and side effects of these adjuvants are dose-related, information about their relative analgesic potencies is lacking, making it difficult to draw meaningful clinical conclusions. The aim of the present study was to assess the relative sparing of ropivacaine by clinically relevant doses of sufentanil and clonidine using the minimum local analgesic concentration (MLAC) model. ⋯ Sufentanil 5 microg and clonidine 75 microg produce similar reductions in the MLAC of ropivacaine. This finding will make feasible the assessment of the side effects of these adjuvants administered at equipotent doses in further studies.