International journal of obstetric anesthesia
-
Int J Obstet Anesth · May 2019
Randomized Controlled TrialUltrasound guided L5-S1 placement of labor epidural does not improve dermatomal block in parturients.
Based on their experience or training, anesthesiologists typically use the iliac crest as a landmark to choose the L3-4 or L2-3 interspace for labor epidural catheter placement. There is no evidence-based recommendation to guide the exact placement. We hypothesized that lower placement of the catheter would lead to a higher incidence of S2 dermatomal block and improved analgesia in late labor and at delivery. ⋯ Placement of an epidural catheter at the L5-S1 interspace using ultrasound did not improve sacral sensory block coverage when compared with an epidural catheter placed at a higher lumbar interspace, without using ultrasound guidance.
-
Int J Obstet Anesth · May 2019
Observational StudyIncidence of respiratory depression after epidural administration of morphine for cesarean delivery: findings using a continuous respiratory rate monitoring system.
Epidural morphine is widely used for postoperative analgesia after cesarean delivery. However, respiratory depression can occur after neuraxial administration of morphine. Previous reports describing respiratory depression in obstetric patients have relied on intermittent visual counting of the respiratory rate. In this study, we estimated the incidence of respiratory depression in patients who had received epidural morphine after cesarean delivery, using a continuous respiratory rate monitoring system with a finger sensor. ⋯ Approximately half the women experienced mild respiratory depression, but only one developed moderate respiratory depression. Continuous respiratory rate monitoring until ambulation may assist in early identification of respiratory depression after neuraxial administration of morphine.
-
Int J Obstet Anesth · May 2019
ReviewTreatment of obstetric post-dural puncture headache. Part 2: epidural blood patch.
The 2009-12 MBRRACE-UK report highlighted the deaths of two women in whom dural puncture had occurred during insertion of a labour epidural catheter. Despite suffering long-term headaches, neither woman was adequately followed-up after discharge from hospital. ⋯ These guidelines have been condensed into two review articles. In this second review, the role of an epidural blood patch is discussed using a question and answer format.
-
Int J Obstet Anesth · May 2019
Letter Randomized Controlled TrialIn vitro intravenous fluid co-load rates with and without an intravenous fluid warming device.
-
Int J Obstet Anesth · May 2019
A 10-year update: national survey questionnaire of obstetric anesthesia units in Israel.
This nationwide survey was conducted to provide data about the obstetric anesthesia services in Israeli labor and delivery units in 2016. ⋯ No new labor units have opened since 2005, despite huge increases in delivery volume in many units. These units manage increased numbers of epidurals and cesarean deliveries. Use of intrathecal morphine for spinal anesthesia has become more widespread. Future efforts should focus on availability of emergency equipment, separate obstetric anesthesia staffing, and establishing emergency protocols.