International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2013
ReviewInteractive technology in obstetric anaesthesia and analgesia: exploring seamless solutions to jagged problems.
Perioperative care often involves treating rapid changes in a patient's physiological profile that requires timely intervention by anaesthetists. Interactive technology and closed-loop systems are currently developed in obstetric anaesthesia and analgesia for maintaining parameters during caesarean section and epidural analgesia. ⋯ The components of an interactive system such as the input sensor or device, microprocessor-based control unit and the effector are introduced. Developments in continuous, non-invasive blood pressure monitoring, control algorithms and smart pump technology would help to redefine how technology can assist obstetric anaesthetists to provide better care and improve clinical outcomes for pregnant women.
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Int J Obstet Anesth · Nov 2013
How UK obstetric anaesthetists assess neuraxial anaesthesia for caesarean delivery: National surveys of practice conducted in 2004 and 2010.
There is much interest in optimal methods of assessing neuraxial block before caesarean delivery. Although cold sensation is commonly used, some evidence suggests that the risk of intraoperative pain may be reduced by assessing light touch. We aimed to determine how neuraxial anaesthesia was managed perioperatively, and whether changes in clinical practice reflected the differing evidence in the literature over six years. ⋯ Methods of assessing neuraxial block differed from those recommended in the literature. The wide range of modalities, methods of testing and targeted sensory levels suggest that clearer recommendations on best practice for assessment and documentation of neuraxial block before caesarean delivery are required.
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There is no globally-accepted definition of epidural failure; this leads to wide differences in reported failure rates. A definition of epidural failure was standardised using a modified Delphi approach involving senior obstetric anaesthetists in the UK. Using this definition, epidural failures were calculated in our institution. ⋯ The study identified epidural failure rates using a standardised definition. This information could be used to guide training decisions and to support doctors during their training period.
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Int J Obstet Anesth · Nov 2013
Assessing blocks after spinal anaesthesia for elective caesarean section: how different questions affect findings from the same stimulus.
A block to touch to T5 is widely used to indicate an adequate level of block for caesarean section with spinal anaesthesia. However, two studies using a "block to light touch" to T5 as their end-point, had a high requirement for intraoperative analgesia and their results cast doubt on the adequacy of a block to touch to T5. On enquiry, these two papers did not assess complete block to touch, but asked mothers when the touch sensation "was the same as" a control stimulus. The difference between these two assessment methods is unknown. The current study presents prospectively collected sensory block data which included both block to touch and the level when touch was the same as a control stimulus. ⋯ When describing a sensory block, not only is it necessary to indicate the exact stimulus used, but it is important to define the actual question asked of the patient. Clinically, block assessment using the first sharp level and touch same as control are equivalent.