International journal of obstetric anesthesia
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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 · Oct 2003
Assessing bupivacaine 10 mg/fentanyl 20 microg as an intrathecal test dose.
After ethics committee approval and verbal consent, women undergoing elective caesarean section given spinal anaesthesia with hyperbaric 0.5% bupivacaine 10 mg (2 mL) plus fentanyl 20 microg (spinal group, n = 20) and women requesting epidural analgesia in labour given the same drugs and doses epidurally, either in the same concentration (epidural small volume group, n = 10) or as 10 mL of 0.1% bupivacaine plus fentanyl 20 microg (epidural large volume group, n = 12) were recruited. The temperature of the great toes, sensory block on the outer ankle (S1 dermatome), motor block at the ankle and haemodynamic changes were recorded every 2 min for 10 min. ⋯ Haemodynamic changes were non-specific. We conclude that bupivacaine 10 mg with fentanyl 20 microg is a reliable agent to detect intrathecal placement by 4 min by which time a combination of motor and sensory block at the ankle and toe warming should be present.
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We conducted a postal survey of lead obstetric anaesthetists in all consultant-led maternity units in the UK about drug errors and the measures taken to reduce or prevent them. Of the 179 out of 240 (75%) who responded, 70 (39%) knew of at least one drug error in their unit during the last year, with 28 of them (40%) experiencing more than one. ⋯ Only 36 respondents (20%) described protocols for checking anaesthetic drugs. Methods described for reducing drug errors were use of coloured labels (20%) or pre-filled labelled syringes (6%), limiting the range of drugs available (6%) and keeping drugs in separate trays once drawn up (6%).
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Int J Obstet Anesth · Oct 2003
Spinal anaesthesia for caesarean section in a patient with Cockayne syndrome.
Cockayne syndrome is a rare inherited disorder with photosensitivity, dysmorphism, short stature and neurological deficits. Sufferers with this condition rarely survive into reproductive life. ⋯ She had a Mallampatti score of 3, so spinal anaesthesia using 1.8 mL of hyperbaric bupivacaine was given with good effect and mother and baby did well. The aetiology and clinical symptoms of this rare congenital syndrome, together with the anaesthetic implications and management, are described and discussed.