International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2008
Comparative StudyVanishing experience in training for obstetric general anaesthesia: an observational study.
Changes in the delivery of anaesthesia for caesarean section have meant that trainee experience in obstetric general anaesthesia has steadily declined. In the UK, working patterns for trainees have changed significantly with the introduction of the New Deal in 2000 and the European Working Time Directive in 2004. Because of an impression that training opportunities had worsened during this period we have reviewed data in obstetric general anaesthesia at St James's University Hospital since 1998. ⋯ Since 1998 training opportunities in general anaesthesia for caesarean section at St James's Hospital have continued to decline. This reflects both changing trends in the delivery of anaesthesia for caesarean section and also changes in training hours and trainee numbers.
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Int J Obstet Anesth · Jul 2008
Randomized Controlled Trial Multicenter StudyVaginal twin delivery: a survey and review of location, anesthesia coverage and interventions.
Twin pregnancies are associated with increased perinatal morbidity and mortality. No consensus exists whether vaginal twin delivery should take place in the labor room or operating room, or whether anesthesiologists should be present. We surveyed members of the California Society of Anesthesiologists (CSA) to review management of vaginal twin delivery, and examined anesthetic intervention retrospectively at our institution. ⋯ There is a lack of consensus regarding the appropriate location for vaginal twin delivery and the role of anesthesiologists. A significant percentage of women undergoing vaginal twin delivery in our institution received anesthetic intervention in the immediate delivery period.
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Int J Obstet Anesth · Jul 2008
Multicenter StudyA survey of labour ward clinicians' knowledge of maternal cardiac arrest and resuscitation.
Guidelines for the management of cardiac arrest during pregnancy exist but they are based on little research. The study hypothesis was that experienced medical clinicians who specialise in obstetric care would not follow current International Liaison Committee on Resuscitation/American Heart Association recommendations in this situation. ⋯ Specialist clinicians who treat pregnant women in hospital on a daily basis possess a limited knowledge of the recommendations for treating maternal cardiac arrest.
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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 · Jul 2008
Comparative StudyComparison of an equal-dose spinal anesthetic for cesarean section and for post partum tubal ligation.
We postulated that a spinal dose of hyperbaric bupivacaine 12 mg and morphine 100 microg administered for cesarean section would yield an equivalent sensory block height and provide sufficient analgesia if administered within 48 h of delivery for postpartum tubal ligation. ⋯ An equivalent dose of hyperbaric bupivacaine 12 mg and morphine 100 microg for both CS and PPTL resulted in a higher sensory block, more hypotension and nausea in CS patients. The studied regimen might be appropriate for PPTL, but appears excessive for CS.