International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2012
Randomized Controlled Trial Comparative StudyA comparison of epidural magnesium and/or morphine with bupivacaine for postoperative analgesia after cesarean section.
Magnesium can potentiate the antinociceptive effect of morphine. This prospective randomized double-blinded study was undertaken to establish the analgesic effect of adding magnesium to epidural morphine during cesarean section. ⋯ Addition of magnesium 500 mg and morphine 1.5mg to epidural 0.1% bupivacaine 10 mL reduced postoperative pain compared with addition of morphine or magnesium alone or no additive.
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Int J Obstet Anesth · Oct 2012
Review Meta AnalysisRisk factors for failed conversion of labor epidural analgesia to cesarean delivery anesthesia: a systematic review and meta-analysis of observational trials.
Multiple labour epidural top-up boluses, caesarean section urgency or care by non-obstetric anaesthetists increase risk of failed epi anaesthesia.
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The α(2) adrenergic receptor agonist dexmedetomidine has some unique pharmacologic properties that could benefit pregnant patients (and their fetuses) when they require sedation, analgesia, and/or anesthesia during pregnancy. The purpose of the present study was to delineate maternal and fetal responses to an intravenous infusion of dexmedetomidine. ⋯ Using a clinically-relevant dosing regimen, intravenous infusion of dexmedetomidine produced significant maternal sedation without altering fetal physiologic status. Results from this initial acute assessment support the conduct of further studies to determine if dexmedetomidine has clinical utility for sedation and pain control during pregnancy.
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Int J Obstet Anesth · Oct 2012
Can the passive leg raise test predict spinal hypotension during cesarean delivery? An observational pilot study.
It was hypothesized that patients who are preload dependent, as demonstrated by a >12% increase in cardiac output in response to a passive leg raise test, would be more likely to exhibit hypotension during spinal anesthesia for cesarean delivery. ⋯ In this pilot study, non-invasive assessment of the hemodynamic response to a volume load was not predictive of hypotension or vasopressor use during cesarean delivery under spinal anesthesia. Fluid responsiveness was related to hemodynamic responses at delivery.