International journal of obstetric anesthesia
-
Int J Obstet Anesth · Oct 2004
Randomized Controlled Trial Clinical TrialEffect of varying doses of fentanyl with low dose spinal bupivacaine for caesarean delivery in patients with pregnancy-induced hypertension.
The purpose of this study was to evaluate haemodynamic stability, perioperative analgesia and neonatal outcome following intrathecal 0.5% bupivacaine 7.5 mg with varying doses of fentanyl, in parturients with pregnancy-induced hypertension. Forty-five parturients with pregnancy-induced hypertension scheduled for caesarean section were randomly allocated to receive 7.5 mg bupivacaine with saline 1 mL (group B), fentanyl 10 microg (group Bf10) or fentanyl 20 microg (group Bf20) intrathecally. Heart rate, blood pressure, and sensory block were recorded at regular intervals. ⋯ Duration of postoperative analgesia was significantly longer in group Bf20 (5.55+/-1.18 h) than in group Bf10 (3.97+/-2.12 h) and group B (3.27+/-1.8 h) (P<0.05). Neonatal outcome was similar in the three groups. Intrathecal fentanyl with low dose bupivacaine provides good surgical anaesthesia and prolongs the duration of analgesia without haemodynamic or neonatal compromise in patients with pregnancy-induced hypertension undergoing caesarean delivery.
-
Int J Obstet Anesth · Oct 2004
Case ReportsMassive amniotic fluid embolism: diagnosis aided by emergency transesophageal echocardiography.
A 36-year-old woman was hospitalized at term and in labor at 3-cm cervical dilatation. The early labor course was remarkable only for oxytocin augmentation and combined spinal-epidural analgesia. Eight hours after admission, tetanic uterine contractions ensued, followed by persistent fetal bradycardia. ⋯ Despite resuscitative efforts, the patient died three hours postoperatively. Autopsy showed extensive microvascular plugging of the pulmonary capillaries by fetal cells in all lung fields. This is a rare case of amniotic fluid embolism diagnosed in part and managed pre-mortem with transesophageal echocardiography and confirmed by autopsy findings.