International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2009
Randomized Controlled Trial Comparative StudyMinimum local analgesic concentrations of ropivacaine and levobupivacaine with sufentanil for epidural analgesia in labour.
Sufentanil is often added to ropivacaine and levobupivacaine to provide epidural analgesia in labour. The aim of this study was to compare the analgesic potencies of epidural ropivacaine and levobupivacaine in combination with sufentanil 0.5 microg/mL, using the minimum local analgesic concentration (MLAC) model with up-down sequential allocation. ⋯ When sufentanil 0.5 microg/mL was added to either ropivacaine or levobupivacaine for labour analgesia, no significant difference in analgesic potency was observed.
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Int J Obstet Anesth · Apr 2009
Randomized Controlled TrialHetastarch co-loading is as effective as pre-loading for the prevention of hypotension following spinal anesthesia for cesarean delivery.
Pre-loading with hetastarch decreases the incidence and severity of hypotension after spinal anesthesia for cesarean delivery. However, pharmacokinetic studies with crystalloid predict that fluid loading should be more efficacious if rapidly administered immediately after induction of spinal anesthesia. The aim of this study was to compare pre- and co-loading of hetastarch for the prevention of hypotension following spinal anesthesia for cesarean delivery. ⋯ Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension after spinal anesthesia for cesarean delivery. Surgery need not be delayed to allow a predetermined pre-load to be administered before induction of spinal anesthesia.
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Int J Obstet Anesth · Apr 2009
Randomized Controlled TrialED95 of phenylephrine to prevent spinal-induced hypotension and/or nausea at elective cesarean delivery.
The purpose of this trial was to determine the 95% effective dose (ED95) of phenylephrine by intermittent i.v. bolus, to prevent spinal-induced hypotension and/or nausea at elective cesarean delivery. ⋯ The ED95 of phenylephrine, administered as intermittent boluses to prevent pre-delivery spinal-induced hypotension and/or nausea at elective cesarean delivery, is at least 122 microg (lower limit of the confidence interval). The safety of this dose warrants further studies.
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Int J Obstet Anesth · Apr 2009
Randomized Controlled TrialAnaesthesia for caesarean section in women with complex cardiac disease: 34 cases using the Braun Spinocath spinal catheter.
Cardiac disease in pregnancy is now the leading medical cause of maternal mortality in the UK. Whilst anaesthesia has not been the precipitant of this morbidity, its safety cannot be taken for granted. Spinal catheter anaesthesia, a relatively uncommon choice in obstetric practice, offers the potential of maintaining haemodynamic stability through accurate and gradual titration of neuraxial blockade. ⋯ Incremental spinal catheter anaesthesia offers effective anaesthesia with excellent haemodynamic control. Post dural puncture headache is of concern, and whilst it may be addressed by product modification, it currently limits widespread use of the Braun Spinocath in obstetric practice.
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Int J Obstet Anesth · Jan 2009
Randomized Controlled Trial Comparative StudyA comparison of paracervical block with single-shot spinal for labour analgesia in multiparous women: a randomised controlled trial.
Epidural and spinal analgesia may be contraindicated or unavailable in labour. This randomised controlled study examined the suitability of paracervical block as an alternative method of labour analgesia. ⋯ Paracervical block was less effective than single-shot spinal analgesia. Both methods were associated with a low incidence of fetal bradycardia but maternal side effects were more common with single-shot spinal analgesia.