International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2003
Time required for surgical readiness in emergency caesarean section: spinal compared with general anaesthesia.
This study set out to compare the time required to be ready for emergency caesarean section using spinal or general anaesthesia. The time for surgical readiness was taken as the time from leaving the delivery room to the time of skin incision. We conducted a retrospective, observational survey in an obstetric tertiary referral hospital delivering over 3000 patients per annum. ⋯ The thirty-minute audit standard is often unrealistic and unnecessary and has little evidence to support its continued use. The new classification of clinical urgency of caesarean section endorsed by the Royal College of Obstetricians and Gynaecologists may clarify those few cases where it is appropriate. The huge reduction in maternal mortality directly due to anaesthesia achieved over the last 30 years must not be compromised in the pursuit of an arbitrary time limit.
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Int J Obstet Anesth · Apr 2003
Target-controlled sedation-analgesia using propofol and remifentanil in women undergoing late termination of pregnancy.
Twenty-one women undergoing termination of pregnancy for severe fetal abnormality received remifentanil and propofol using a target-controlled infusion system and were studied prospectively. Target concentrations were initially set at 1 ng.mL(-1) for remifentanil and 0.8 microg.mL(-1) for propofol. Remifentanil concentration was adjusted to obtain visual analog scores <50 mm with preservation of ventilation. ⋯ No episodes of ventilatory depression, nausea, vomiting or pruritus were noted. Patients scored analgesia as excellent in 12 cases, good in 7 cases and moderate in 2 cases. Further studies are required to determine the place and the best regimen of remifentanil infusion for pain management in labor in those cases when epidural analgesia is contraindicated.
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Int J Obstet Anesth · Apr 2003
The direct depressant effects of desflurane and sevoflurane on spontaneous contractions of isolated gravid rat myometrium.
Our purpose was to investigate the direct depressant effects of desflurane and sevoflurane at 0.5, 1 and 2 minimum alveolar concentrations (MAC) on spontaneous contractions of isolated gravid rat myometrium. Ten gravid, albino Wistar rats, weighing 240-310 g and at 19-20 days' gestation were used. Sixty myometrial strips were obtained from 10 rats, and randomly assigned into six groups of 10. ⋯ The frequency of contractions was decreased 21.2% with 1 MAC desflurane versus 17.1% with 1 MAC sevoflurane. The amplitude and frequency of contractions were decreased 48.2% and 48.7% with 2 MAC desflurane versus 58.9% and 49.3% with 2 MAC sevoflurane, respectively. We suggest that due to tocolytic activity, desflurane and sevoflurane can be useful in non-obstetric surgery during pregnancy.
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Int J Obstet Anesth · Apr 2003
Postpartum headaches: summary report of the National Obstetric Anaesthetic Database (NOAD) 1999.
The National Obstetric Anaesthetic Database was established in 1998 to support collection of national data on obstetric analgesia and anaesthesia. The first year's project aimed to determine the incidence, characteristics, contributing factors and management of postpartum headaches with anaesthetic interventions. A total of 65348 women were reported to have had anaesthetic interventions. ⋯ The incidence of headache ranged from 1.1% to 1.9% between all anaesthetic techniques but increased to 11% for women receiving multiple regional anaesthetics. The predominant characteristics of PDPH were limitation of daily activity (n=305, 75%), severity (moderate/severe) and a postural element (n = 325, 80%), all significantly different from headache from other causes (P = 0.001). Shoulder/neck stiffness (n=172, 43%) was the commonest symptom associated with PDPH.