International journal of obstetric anesthesia
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Headache is a common puerperal complaint. A wide variety of factors can be involved, ranging from hormonal shifts, physiological changes, and peripartum procedures that may precipitate, worsen, or cause troublesome headache. The differential diagnosis of postpartum headache is broad and potentially daunting to the various clinicians caring for the postpartum patient. ⋯ This review will focus on the main causes of postpartum headache, their incidence, and clinical presentation. Causes of postpartum headache that will be covered include benign primary headache disorders such as migraine and tension type headache as well as secondary headache disorders such as postdural puncture headache, stroke, and venous sinus thrombosis. A structured approach to headache evaluation in the postpartum patient will be presented to help differentiate the possible causes of headache.
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Int J Obstet Anesth · Oct 2010
Randomized Controlled Trial Comparative StudyA randomized comparison of automated intermittent mandatory boluses with a basal infusion in combination with patient-controlled epidural analgesia for labor and delivery.
Automated mandatory boluses (AMB), when used in place of a continuous basal infusion, have been shown to reduce overall local anesthetic consumption without compromising analgesic efficacy in patient-controlled epidural analgesia (PCEA). We hypothesized that our PCEA+AMB regimen could result in a reduction of breakthrough pain requiring epidural supplementation in comparison with PCEA with a basal infusion (PCEA+BI). ⋯ PCEA+AMB, when compared to PCEA+BI, confers greater patient satisfaction and a longer duration of effective analgesia after CSE despite reduced analgesic consumption.
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Int J Obstet Anesth · Oct 2010
Randomized Controlled TrialUltrasound decreases the failed labor epidural rate in resident trainees.
Epidural analgesia is widely used for pain relief during labor. The purpose of this study was to determine if ultrasound measurement of the depth from skin to epidural space before the epidural technique decreases the failure rate of labor analgesia. A secondary objective was to correlate ultrasound depth to the epidural space with actual depth of the needle at placement. ⋯ Ultrasound measurement of the epidural space depth before epidural technique placement decreases the rate of epidural catheter replacements for failed labor analgesia, and reduces the number of epidural attempts when performed by first year residents and compared to attempts without ultrasound guidance.
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Int J Obstet Anesth · Oct 2010
Obstetric anesthesia units in Israel: a national questionnaire-based survey.
This survey was performed to assess the organization and practice of obstetric anesthesia units in Israel. ⋯ In this national appraisal of Israeli obstetric anesthesia services, a notable lack of written protocols, wide variations in staffing, and few specifically trained obstetric anesthesia personnel were observed.