International journal of obstetric anesthesia
-
Int J Obstet Anesth · Jan 2007
Randomized Controlled TrialEffect of sufentanil on minimum local analgesic concentrations of epidural bupivacaine, ropivacaine and levobupivacaine in nullipara in early labour.
The aim was to assess the effect of epidural sufentanil on relative analgesic potencies of epidural bupivacaine, ropivacaine and levobupivacaine by determining the minimum local analgesic concentrations during labour. ⋯ Local anaesthetic requirements for bupivacaine, levobupivacaine and ropivacaine follow an analgesic potency hierarchy. Any potency differences are small when compared to the effect of sufentanil, which resulted in a four-fold reduction in local anaesthetic requirements. Sufentanil may also enhance the potency differences between bupivacaine and the two S-enantiomer agents.
-
Int J Obstet Anesth · Jan 2007
Randomized Controlled TrialDose response to intrathecal diamorphine for elective caesarean section and compliance with a national audit standard.
This double-blind randomised controlled trial investigated the most appropriate dose of intrathecal diamorphine to use with high-dose diclofenac as part of a multimodal analgesic regimen for caesarean section under subarachnoid block. We also wished to establish whether it was possible to satisfy the Royal College of Anaesthetists postoperative pain audit recommendation for this patient group. ⋯ We found that for elective caesarean section under subarachnoid block with high dose diclofenac, analgesia was optimal with 300 microg of intrathecal diamorphine. Even the highest dose of intrathecal diamorphine did not achieve the Royal College of Anaesthetists postoperative audit target that 90% of patients should have a pain score of no more than 3/10. We believe that this target is too arduous.
-
Int J Obstet Anesth · Jan 2007
Case ReportsAnesthesia for cesarean section in a patient with Holt-Oram syndrome.
Holt-Oram syndrome is a rare genetic disorder affecting the heart and upper limbs (atriodigital dysplasia). The manifestations of the limb defects may vary in severity from subtle carpal bone defects and triphalangeal thumb to digit aplasia and upper extremity phocomelia. ⋯ Our goal was to avoid an excessively high sympathetic block or excessive sympathetic stimulation accompanied by potential deleterious effects on cardiac rhythm. Cardiac monitoring was continued in the postoperative period for 6 h because of the possibility of dysrhythmia.
-
We describe a patient who presented in late pregnancy with deteriorating neurological status due to an intracranial capillary haemangioma causing mass effect and raised intracranial pressure. She became confused and uncooperative leading to practical difficulties in performing adequate radiological imaging. Decision regarding timing of delivery and craniotomy was not straightforward and required discussion between the neurosurgeon, obstetrician and anaesthetist based on assessment of fetal maturity and the need to perform a craniotomy to excise what was initially thought to be a meningioma. ⋯ Both of these may influence the choice of labour analgesia or anaesthesia for caesarean section. Anaesthetists must be aware of the difficulties of radiological imaging during pregnancy, particularly in confused patients. The conflicting requirements of general anaesthesia for craniotomy and caesarean section should be considered.
-
Int J Obstet Anesth · Jan 2007
Case ReportsReversible posterior leucoencephalopathy syndrome in a peripartum patient.
We present the case of a multiparous parturient who developed hypertension associated with a severe headache in the immediate post-partum period. She subsequently suffered a generalised tonic clonic seizure on the fifth post-partum day. ⋯ The magnetic resonance imaging findings were consistent with vasogenic oedema in the right posterior parieto-occipital white matter and these in turn are consistent with reversible posterior leucoencephalopathy syndrome. The differential diagnosis of convulsions in the post-partum period is discussed and the clinical and radiological features of reversible posterior leucoencephalopathy syndrome are described.