International journal of obstetric anesthesia
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In the UK earlier discharge of patients following elective caesarean section would require that more patients are discharged the day after surgery. The introduction of enhanced recovery in other specialties has resulted in shorter postoperative stay. We surveyed current U.K. practice to find whether this was consistent with enhanced recovery and what changes units would need to introduce to establish such a programme. ⋯ Most obstetric units support the concept of enhanced recovery following caesarean section and many could introduce a programme for elective surgery with relatively small changes in patient care.
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Int J Obstet Anesth · May 2014
Observational StudyObservational study of changes in epidural pressure and elastance during epidural blood patch in obstetric patients.
During an epidural blood patch, we inject blood until the patient describes mild back pressure, often leading to injection of more than 20 mL of blood. We undertook this study to measure the epidural pressures generated during an epidural blood patch and to identify the impact of volume on epidural elastance in obstetric patients. ⋯ We found a curvilinear relationship between the volume of blood injected during an epidural blood patch and the pressure generated in the epidural space. However, there was a large variation in both the volume of blood and the epidural pressure generated. The clinical importance of this finding is not known. A larger study would be required to demonstrate whether pressure is a predictor of success.
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Int J Obstet Anesth · May 2014
Randomized Controlled TrialEffects of a head elevated ramped position during elective caesarean delivery after combined spinal-epidural anaesthesia.
Elevating the torso in a Head Elevated Ramped Position during caesarean delivery benefits the mother by improving comfort and ventilation while reducing reflux symptoms and providing a better airway position. We hypothesised that using an elevation pillow for an elective caesarean delivery under combined spinal-epidural anaesthesia would not significantly increase the time to achieve a T4 block. ⋯ Elevating the parturient undergoing elective caesarean delivery into the Head Elevated Ramped Position immediately or once the block had been established did not appear to significantly alter time to an adequate block height of T4; however, the need for epidural supplementation was greater in the intervention groups. Cautious use of this novel position change can provide a more comfortable experience and provide a better airway position should conversion to general anaesthesia be required.
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Int J Obstet Anesth · May 2014
Case ReportsAn intrathecal catheter in a pregnant patient with idiopathic intracranial hypertension: analgesia, monitor and therapy?
Idiopathic intracranial hypertension is important for the obstetric anaesthetist as it is mostly seen in obese women of childbearing age. The incidence is likely to increase as the obesity pandemic grows. ⋯ We successfully managed labour analgesia in a parturient with idiopathic intracranial hypertension with an intrathecal catheter. The possibility of using this catheter as a cerebrospinal fluid drain and pressure monitor was considered and is discussed along with potential complications.
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Int J Obstet Anesth · May 2014
An audit of the efficacy of a structured handover tool in obstetric anaesthesia.
The SAFE handover tool was developed to reduce critical omissions during handovers in obstetric anaesthesia. It comprises a simple proforma onto which the outgoing team documents patients who fall into one of four anaesthetically relevant categories: Sick patients; At-risk patients (of emergency caesarean section, major haemorrhage or anaesthetic problems); Follow-ups; and Epidurals. We hypothesised that its use would reduce the number of critical omissions at handover. ⋯ The SAFE handover tool significantly increased handover rates of anaesthetically relevant parturients. It is easy to remember and consistent with UK National Health Service Litigation Authority's guidance on risk management in maternity units.