International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2005
Case ReportsSpontaneous acute thoracic epidural hematoma causing paraplegia in a patient with severe preeclampsia in early labor.
This is a case of acute spontaneous thoracic epidural hematoma in a laboring patient at term who presented with severe preeclampsia and acute spinal cord compression, paraplegia, and sensory loss below T8. In early labor, at home, the patient experienced sudden lumbar back pain that progressed to mid-scapular pain leading to paraplegia and T8 sensory loss within one hour of onset of pain. Her symptoms were caused by a spontaneous thoracic epidural hematoma. ⋯ Following cesarean section under general anesthesia, thoracic laminectomy was performed and an epidural hematoma compressing the spinal cord to 2-3 mm was evacuated 13 h after the onset of symptoms. After approximately three months of paraplegia, five months with quad-walker and cane use, the patient can now walk with a cane or other minimal support but has remaining bowel and bladder problems. The conflicting anesthetic management objectives of severe preeclampsia and acute paraplegia secondary to spinal epidural hematoma required compromise in the management of her preeclampsia in order to preserve spinal cord perfusion.
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Int J Obstet Anesth · Jul 2005
Antenatal anaesthetic assessment of high-risk pregnancy: a survey of UK practice.
Anaesthetists are frequently involved in the management of high-risk pregnancy. Antenatal referral permits time to prepare an appropriate management plan for labour and delivery. This survey looked at current methods of referral in the UK and the role of a formal clinic. ⋯ Most hospitals were satisfied with current arrangements for referral of high-risk pregnancy. A mechanism for anaesthetic referral of high-risk pregnancy is vital, but in many units is not via a formal clinic.
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Int J Obstet Anesth · Jul 2005
Randomized Controlled Trial Clinical Trial"Ultra-light" patient-controlled epidural analgesia during labor: effects of varying regimens on analgesia and physician workload.
Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for maintenance of labor analgesia. Some of these benefits may depend on the PCEA settings. This study evaluated several regimens for "ultra-light" (0.125%) PCEA with basal continuous infusion (CI) in labor with goals of minimizing physician interventions while providing good analgesia. ⋯ These ultra-light PCEA regimens provided excellent analgesia with minimal physician workload and a high spontaneous delivery rate. Use of moderate to high-volume, ultra-light PCEA/CI techniques should facilitate provision of labor analgesia in busy obstetric units.
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Int J Obstet Anesth · Jul 2005
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of epidural ropivacaine 0.75% and bupivacaine 0.5% with fentanyl for elective caesarean section.
Early studies suggested that ropivacaine had clinical advantages over bupivacaine with respect to cardiotoxicity and motor block, and that it was suitable for epidural caesarean section. This study was set up to compare epidural 0.75% ropivacaine with a popular bupivacaine/fentanyl mixture for elective caesarean section. ⋯ This study suggests that epidural 0.75% ropivacaine without opioid may be used as an alternative to bupivacaine 0.5% with fentanyl for elective caesarean section, but it does not induce anaesthesia any faster and may result in a denser, more prolonged, motor block.
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Int J Obstet Anesth · Jul 2005
Randomized Controlled Trial Clinical TrialA randomized comparison of a five-minute versus fifteen-minute lockout interval for PCEA during labor.
The best combination of bolus size and lockout interval for patient-controlled epidural analgesia (PCEA) is not known. This study compared a 5-min with a 15-min lockout interval. ⋯ The 5-min lockout interval appears the more efficient and has been used safely in our practice for 15,000 parturients, although a larger study is required to confirm the relative efficacy, efficiency and safety of this regimen.