International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2008
Randomized Controlled Trial Comparative StudyEstimation of the minimum motor blocking potency ratio for intrathecal bupivacaine and lidocaine.
The up-down sequential allocation model has been adapted to investigate a variety of clinical and pharmacological issues in neuraxial anaesthesia including the estimation of relative potency ratios for analgesia and motor block of the most commonly used epidural and intrathecal local anaesthetics. The aim of this study was to establish the median effective doses (ED50) for motor block with intrathecal lidocaine and bupivacaine and to define the relative motor blocking potency ratio. ⋯ Intrathecal bupivacaine was 4.1 times more potent than lidocaine for motor block.
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Int J Obstet Anesth · Jul 2008
Randomized Controlled TrialSpinal anesthesia with sequential administration of plain and hyperbaric bupivacaine provides satisfactory analgesia with hemodynamic stability in cesarean section.
Hypotension during spinal anesthesia is one of the major concerns in cesarean section. To achieve adequate spinal anesthesia with less hypotension, we evaluated the viability of sequential subarachnoid injection of two different baricities of bupivacaine. We used plain bupivacaine 5mg to obtain dense anesthesia of the surgical site, followed by hyperbaric bupivacaine 5mg to achieve spread to T5 anesthesia to address visceral pain. ⋯ Sequential subarachnoid injection of plain and hyperbaric bupivacaine for cesarean section can provide reliable spinal anesthesia with a lower incidence of hypotension and vomiting.
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Int J Obstet Anesth · Apr 2008
Randomized Controlled TrialRemifentanil for cesarean section under general anesthesia: effects on maternal stress hormone secretion and neonatal well-being: a randomized trial.
Remifentanil may attenuate maternal hemodynamic response during cesarean section under general anesthesia, but could cause transient but significant neonatal depression. We investigated the effect of low-dose remifentanil on maternal neuroendocrine response and fetal wellbeing. ⋯ Remifentanil administration before peritoneal incision partially reduced the hormonal stress response. Maternal benefits must be weighed against transitory but significant neonatal respiratory depression. Neonatal resuscitation facilities are mandatory when remifentanil is used.
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Int J Obstet Anesth · Apr 2008
Randomized Controlled Trial Comparative StudyA randomized comparison of levobupivacaine, bupivacaine and ropivacaine with fentanyl, for labor analgesia.
To compare the analgesic efficacy of epidural infusions of levobupivacaine, bupivacaine and ropivacaine in labor. ⋯ All three regimens were effective during first stage of labor although pain scores were higher in those receiving levobupivacaine. Motor block was greater with bupivacaine than with levobupivacaine.
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Int J Obstet Anesth · Apr 2008
Randomized Controlled Trial Comparative StudyThe incidence of maternal fever during labor is less with intermittent than with continuous epidural analgesia: a randomized controlled trial.
This prospective, randomized study was performed to see if intermittent labor epidural analgesia was protective against maternal intrapartum fever, compared to continuous epidural infusion. ⋯ Intermittent epidural injections appear to protect against intrapartum fever in the first 4 hours of labor analgesia, compared to continuous infusion. This may be due to intermittent partial recovery of heat loss mechanisms between injections. Neonatal sepsis evaluation rates were similar in the two groups.