International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2009
Multicenter StudyThe preparation and storage of anaesthetic drugs for obstetric emergencies: a survey of UK practice.
Traditionally anaesthetic drugs for obstetrics are prepared as a contingency and stored until they are required for emergency use or have expired. Expiry is based on presumed reduction in sterility and efficacy although evidence for this is inconsistent. Preparation in advance introduces the risk of error and potential for tampering by a third party. Discarding and re-preparing drugs daily represents significant wastage with associated cost implications. We predicted that practice of drug preparation would differ widely across the UK, so conducted a national survey. ⋯ The majority of UK obstetric units routinely draw up emergency drugs every 24h. With conflicting evidence regarding sterility and efficacy this represents tremendous wastage and potential for drug error and tampering. We propose that nationwide introduction of commercially- and pharmacy-prepared drugs with long shelf lives would improve safety and cost effectiveness.
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Int J Obstet Anesth · Jul 2009
Obstetric anaesthesia outcome in obese and non-obese parturients undergoing caesarean delivery: an observational study.
Maternal obesity is increasing in prevalence and is associated with an increased risk of perioperative complications. This study evaluates the impact of obesity on perioperative outcomes in parturients undergoing caesarean delivery. ⋯ Neuraxial anaesthesia was effective for caesarean deliveries in obese and non-obese, in elective and emergency cases. Maternal obesity is associated with increased difficulty in performing neuraxial anaesthesia, but not with increased failure rate. Our study found no differences between obese and non-obese parturients in rate of caesarean deliveries, co-morbidities, indications for delivery or anaesthesia complications.
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Int J Obstet Anesth · Jul 2009
An observational prospective cohort study of incidence and characteristics of failed spinal anaesthesia for caesarean section.
A prospective cohort study was performed in 800 parturients undergoing elective caesarean section under spinal anaesthesia from May 2005 to April 2006 in a large maternity hospital in Singapore, in order to determine the incidence of and risk factors for total and partial failure of spinal anaesthesia. ⋯ Spinal anaesthesia using bupivacaine 10 mg with morphine 100 microg produces reliable anaesthesia for elective caesarean section. Postpartum sterilization involves exteriorisation of the uterus with additional surgical manipulation and hence may necessitate analgesic supplementation. The initial use of a combined spinal-epidural technique or the addition of intrathecal fentanyl or clonidine or an increased dose of local anaesthetic may be considered to decrease the incidence of intraoperative pain.
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Int J Obstet Anesth · Jul 2009
Letter Case ReportsCaesarean section for a woman with Von Hippel-Lindau disease.