International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2006
Randomized Controlled TrialCombined low-dose spinal-epidural anesthesia versus single-shot spinal anesthesia for elective cesarean delivery.
Combined spinal-epidural anesthesia balancing low-dose intrathecal bupivacaine/fentanyl and low-dose epidural bupivacaine may be more useful than single-shot spinal anesthesia for cesarean delivery in reducing incidences of adverse effects such as hypotension and nausea and in shortening motor recovery. Combined spinal-epidural anesthesia (n=50) or spinal anesthesia (n=50) was randomly performed in 100 parturients. Intrathecal bupivacaine 6 mg added by fentanyl 20 mug followed after 5 min by 10 mL of 0.25% epidural bupivacaine were used for combined spinal-epidural and intrathecal bupivacaine 9 mg with fentanyl 20 mug for spinal anesthesia. ⋯ Patients in the spinal group had denser motor block in the extremities and a higher incidence of hypotension (P<0.05) and nausea and vomiting (P<0.05). Motor recovery was faster in the combined spinal-epidural group (P<0.001). We concluded that combined spinal-epidural anesthesia using low-dose local anesthetic-opioid spinal anesthesia and routine epidural supplementation before surgery had some potential advantages over single-shot spinal anesthesia in the lower incidences of adverse effects and quicker recovery.
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Int J Obstet Anesth · Jan 2006
Comparative StudyEvaluation of the platelet function analyzer (PFA-100) vs. the thromboelastogram (TEG) in the parturient.
The platelet function analyzer (PFA-100) is a bedside test of coagulation designed to evaluate platelet function. It measures the time required for whole blood to occlude a membrane impregnated with either epinephrine (EPI) or adenosine 5'diphosphate (ADP). The results are reported as closure time (CT-EPI or CT-ADP) in seconds. The thromboelastogram (TEG) measures whole blood clotting and the maximum amplitude (MA) correlates with platelet count and function. We wished to establish whether there is a correlation between the CT and platelet count, between the CT and MA, and between the MA and platelet count. ⋯ We conclude that the CT does not correlate with the platelet count or MA in the parturient, but the TEG does. Therefore the TEG may be a better tool to evaluate coagulation in the parturient with thrombocytopenia.
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We have previously reported that measurement of non-invasive blood pressure during caesarean section under spinal anaesthesia fails in over 50% of cases. We felt that errors would be less likely if blood pressure could be measured at the ankle as it is immobile during caesarean section. The purpose of our study was to determine whether blood pressure measurement at the ankle was equivalent to the arm. ⋯ We cannot recommend the use of the ankle to measure blood pressure during caesarean section.
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Int J Obstet Anesth · Jan 2006
Use of an information leaflet to improve general practitioners' knowledge of post dural puncture headache.
The number of women receiving neuraxial anaesthesia for labour and delivery is increasing. Women are also being discharged into the community sooner after delivery. Thus, complications arising from neuraxial anaesthesia may present to general practitioners, so it is of vital importance that they are familiar with and can manage potential problems associated with these anaesthetic techniques. ⋯ By comparing the two sets of answers, we demonstrated that the leaflet has successfully improved knowledge of post dural puncture headache and other potential sequelae of obstetric epidural analgesia among general practitioners.