International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2004
Randomized Controlled Trial Clinical TrialA randomized, double-blind, placebo-controlled trial of ramosetron for preventing nausea and vomiting during termination of pregnancy.
Women undergoing general anesthesia for dilatation and curettage have a high risk for postoperative nausea and vomiting. We therefore evaluated the efficacy and safety of ramosetron, a new compound having serotonin receptor antagonist activity, for preventing nausea and vomiting in termination of pregnancy. Eighty women scheduled for dilatation and curettage received, in a randomized, double-blind manner, an intravenous placebo or ramosetron at three different doses (0.15 mg, 0.3 mg, 0.6 mg) at the end of surgery (n = 20 per group). ⋯ No clinically serious adverse events due to the study drugs were observed in any group. Our results suggest that ramosetron 0.3 mg is an effective antiemetic for prophylaxis against emetic symptoms after dilatation and curettage. Increasing the dose to 0.6 mg provides no further benefit.
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Int J Obstet Anesth · Jan 2004
Randomized Controlled Trial Clinical TrialIntrathecal fentanyl-induced pruritus during labour: the effect of prophylactic ondansetron.
Fentanyl is commonly used for spinal analgesia during labour but it is associated with a high incidence of pruritus. This randomised, double-blind, placebo-controlled study was performed to evaluate the effect of prophylactic ondansetron on the incidence and severity of pruritus among parturients receiving intrathecal fentanyl as part of combined spinal-epidural analgesia. Seventy-three women were randomised to receive either saline placebo (group P, n = 25), ondansetron 4 mg (group O4, n = 23) or ondansetron 8 mg (group O8, n = 25) intravenously before intrathecal fentanyl 25 micrograms and bupivacaine 2 mg. ⋯ There were no significant differences between groups for severity of pruritus or requirement for treatment (naloxone given to 45%, 28% and 35% of groups P, O4 and O8 respectively). Secondary outcomes such as the incidence of headache, pain and nausea were not significantly different between groups. We conclude that prophylactic ondansetron 4 or 8 mg intravenously was ineffective in reducing the incidence or severity of intrathecal fentanyl-induced pruritus during labour.
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Int J Obstet Anesth · Jan 2004
Randomized Controlled Trial Comparative Study Clinical TrialStandard preoxygenation technique versus two rapid techniques in pregnant patients.
The aim of this study was to compare three different preoxygenation techniques in pregnant women by measuring end-tidal fractional oxygen concentration (FETO2): the traditional technique of 3min tidal volume breathing (VT x 3 min), 8 deep breaths (8 DB) and 4 deep breaths (4 DB). Twenty pregnant volunteers without pulmonary diseases were studied during the third trimester (36-38 weeks' gestation). Women were preoxygentated using a non-rebreathing respiratory circuit with a 3-L reservoir bag and a Capnomac Ultima calibrated before each patient to monitor FETO2 continuously. ⋯ The average time required for obtaining an FETO2 >/= 90% was 107+/-37s. Both the VT x 3 min and the 8 DB techniques are therefore more effective for preoxygenation in pregnant patients than the 4 DB technique. In an acute obstetric emergency before rapid-sequence induction of general anaesthesia, 8 DB preoxygenation technique could be recommended.
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Int J Obstet Anesth · Jul 2002
Randomized Controlled Trial Clinical TrialA comparative study of three different doses of 0.5% hyperbaric bupivacaine for spinal anaesthesia in elective caesarean section.
We conducted a double-blind comparison of three doses (7.5 mg, 8.75 mg and 10 mg) of 0.5% hyperbaric bupivacaine in women undergoing elective caesarean under spinal anaesthesia. Sixty women were randomised into 3 groups of 20. Group A received 7.5 mg, group B 8.75 mg and C 10 mg of study drug. ⋯ The incidence of hypotension was greater in groups B and C than in group A (P < 0.05). Group C women had a greater incidence of bradycardia than did groups A and B (P < 0.05). The 7.5-mg dose of 0.5% hyperbaric bupivacaine was observed to provide acceptable analgesia without any significant incidence of adverse effects such as maternal hypotension or bradycardia.
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Int J Obstet Anesth · Jul 2002
Randomized Controlled Trial Clinical TrialHaemodynamic changes caused by oxytocin during caesarean section under spinal anaesthesia.
The haemodynamic effects of oxytocin receive scant attention in pharmacology texts, but may be clinically significant in vulnerable patients. Despite prescriber information recommending a dose of 5 international units by slow i.v. injection, it is the authors' experience that it is very common practice in the UK to give 10 units as a rapid injection. We therefore conducted a randomised, double-blind study of the haemodynamic changes induced by rapid bolus of 5 or 10 units of oxytocin in 34 healthy term parturients at caesarean section under spinal anaesthesia. ⋯ This has been illustrated by a maternal death reported to the Confidential Enquiries into Maternal Deaths in the United Kingdom. The need to adhere to a dose regimen of 5 units by slow injection needs re-emphasis, but no evidence exists to claim that even this will be haemodynamically inert. We therefore recommend that oxytocin boluses be avoided in women with hypovolaemia or cardiac disease.