International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2009
Randomized Controlled TrialA randomized study of maternal serum cytokine levels following cesarean section under general or neuraxial anesthesia.
Cytokines are significant mediators of the immune response to surgery and also play a role in parturition. The aim of the study was to investigate the impact of the anesthetic technique for cesarean section on plasma levels of cytokines IL-6 and TNF-alpha. ⋯ Under the present study design anesthetic technique did not affect IL-6 or TNF-alpha concentrations in parturients undergoing elective cesarean section. Serum IL-6 levels increased 24 h postoperatively independently of anesthetic technique.
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Int J Obstet Anesth · Jan 2009
Case ReportsEpidural analgesia in labor for a woman with an intrathecal baclofen pump.
A 28-year-old woman in active labor at 38 weeks of gestation requested epidural analgesia. She had previously received an intrathecal baclofen infusion pump to relieve the spasticity of cerebral palsy. She had right hemiparesis and cerebral palsy but was otherwise healthy. ⋯ For labor analgesia the epidural space was identified at L4-5 with the patient sitting, using a standard 17-gauge Tuohy needle. An epidural catheter was threaded to 5 cm and provided effective analgesia until delivery four hours later. There were no postnatal complications.
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Int J Obstet Anesth · Jan 2009
Case ReportsLow-dose combined spinal-epidural anaesthesia for caesarean section in a patient with Eisenmenger's syndrome.
A 34-year-old woman (G3,P0) with Eisenmenger's syndrome and positive HIV serology presented to hospital at 16 weeks of pregnancy. She was hospitalised at 20 weeks under the care of a multidisciplinary team. At 33 weeks caesarean section was performed under low-dose combined spinal-epidural anaesthesia using a needle-through-needle technique. ⋯ The caesarean section proceeded uneventfully without pain or discomfort. The post-partum period was without major incident. Low-dose combined spinal-epidural techniques combine the advantages of spinal and epidural blockade; the versatility allows its use in a wide range of clinical conditions, combining effective anaesthesia with cardiovascular stability.
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Int J Obstet Anesth · Jan 2009
Chronobiology of parturients receiving neuraxial labour analgesia with ropivacaine and fentanyl: a prospective cohort study.
The circadian variation in biologic rhythm has been known to affect labour pain. The duration of action of ropivacaine or fentanyl used in treatment of labour pain has been demonstrated to vary with different times of the day. The aim of this study is to find whether the need for epidural supplementation for breakthrough pain is significantly affected by the time of day, in patients who are on a continuous epidural infusion of these drugs. ⋯ Parturients with labour onset and neuraxial analgesia request in the evening and night experienced higher pain scores. However, no significant differences in the incidence of breakthrough pain or the quality of analgesia were observed with the provision of commonly used concentrations of ropivacaine with fentanyl via continuous epidural infusion.
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Int J Obstet Anesth · Jan 2009
Multicenter StudyThe impact of a teaching program on obstetric anesthesia practices in Croatia.
Many countries fail to use regional techniques for either labor analgesia or obstetric anesthesia. Kybele, an international outreach group, seeks to improve obstetric anesthesia practices worldwide. Its educational program in Croatia was evaluated by studying the change in use of regional anesthetic techniques in obstetrics after a Kybele visit. ⋯ In Croatia, a two-week educational program in obstetric anesthesia increased the use of regional anesthesia and analgesia for labor and delivery in the year that followed the program. Multiple factors limit availability of analgesia for childbirth in Croatia.