International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2006
Randomized Controlled TrialA randomised double-blinded controlled trial of the effect of diluent volume on the efficacy of a single dose of epidural ropivacaine for labour analgesia.
Few studies have systematically investigated the effect of diluent volume on the efficacy of epidural local anaesthetics for labour analgesia and no data are available for ropivacaine. Our aim was to compare epidural ropivacaine given in three different volumes for labour analgesia. ⋯ Under the conditions of this study, within the range of 5-20 mL, the volume and concentration were not significant factors influencing the efficacy of a single 30-mg bolus of epidural ropivacaine given for labour analgesia. This suggests that the most important factor influencing analgesic efficacy was drug mass.
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Int J Obstet Anesth · Jul 2006
Case ReportsLabor epidural placement in a woman with a cervical spinal cord stimulator.
A 37-year-old female, gravida 1 para 0, in active labor at term, with a cervical spinal cord stimulator in situ, presented for epidural analgesia for labor. She had received the cervical spinal cord stimulator some 30 months before, to treat chronic regional pain syndrome I. She was taking no medication, and was thin but otherwise healthy. ⋯ Her labor and delivery proceeded uneventfully. The spinal cord stimulator continued to function well throughout the entire process. She noticed that the feeling in her right hand returned to baseline after the delivery.
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Int J Obstet Anesth · Jul 2006
Case ReportsFoot drop after spinal anesthesia in a patient with a low-lying cord.
Damage to the spinal cord/conus medullaris due to incorrect identification of the lumbar space is a known complication of lumbar puncture. However, damage to a low-lying cord using an appropriate interspace is extremely rare. ⋯ She developed right foot drop immediately after surgery, which gradually recovered over the next 10 months. Magnetic resonance imaging revealed a low lying cord with a fatty filum terminale and intramedullary T2 hyperintensity, suggestive of needle damage.
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Int J Obstet Anesth · Jul 2006
Case ReportsAnesthetic management for emergency cesarean section in a patient with severe valvular disease and preeclampsia.
Wider selection of young patients for prosthetic valve replacement for valvular heart disease has resulted in an increase in number of women with heart disease reaching childbearing age. Such patients presenting in labor for emergency cesarean section require special consideration. ⋯ The goals of our anesthetic management included (1) careful airway management (2) maintaining stable hemodynamics (3) optimizing fluid status, and (4) preventing seizures. Issues related to management of patients with severe valvular disease, prosthetic valves and complications due to anticoagulant therapy during pregnancy are discussed.
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Int J Obstet Anesth · Jul 2006
Reports on Confidential Enquiries into Maternal Deaths: management strategies based on trends in maternal cardiac deaths over 30 years.
In the latest Report of the Confidential Enquiries into Maternal and Child Health (CEMACH; formerly Confidential Enquiries into Maternal Deaths (CEMD)), cardiac disease was the second commonest cause of maternal mortality. Currently there is much emphasis on appropriate referral and multidisciplinary planning for women with known cardiac disease. ⋯ Therefore, while there is a continuing need to counsel, refer and appropriately manage women with known pre-existing cardiac disease, attention must also be paid to screening women before pregnancy for evidence of cardiac disease or risk factors, and also to cardiac disease that develops de novo during pregnancy, since early screening and referral strategies alone will not prevent units from encountering such cases. All units therefore require processes for monitoring and managing women for the development of cardiac disease throughout their pregnancies.