International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2003
Impact study of the introduction of low-dose epidural (bupivacaine 0.1%/fentanyl 2 microg . mL(-1)) compared with bupivacaine 0.25% for labour analgesia.
We conducted a retrospective analysis of the obstetric effects of introducing a low-dose epidural regimen for epidural analgesia in labour. Before this, all women in our unit requesting epidural analgesia for labour received intermittent boluses (10 mL) of 0.25% bupivacaine. After the introduction of the low-dose service in March 2000, intermittent boluses (10 mL) of 0.1% bupivacaine with fentanyl 2 microg . mL(-1) were given. ⋯ Maternal satisfaction was high in both groups (95 and 97%, respectively). We conclude that the introduction of a low-dose regimen of epidural analgesia for labour reduces the incidence of instrumental deliveries. It also decreases the incidence of bladder catheterisation during labour, but the need for anaesthetic intervention may be greater.
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Int J Obstet Anesth · Jan 2003
Retrospective review of spinal versus epidural anaesthesia for caesarean section in preeclamptic patients.
A 5-year retrospective survey of anaesthesia for caesarean section for mild/moderate and severe preeclampsia was performed, covering the period between 1 January 1996 and 31 December 2000. One hundred and twenty-one cases of non-labouring preeclamptic patients receiving spinal or epidural anaesthesia for caesarean section were included for analysis. Comparisons were made of the lowest blood pressures recorded before induction of anaesthesia, during the period from induction to delivery and the period from delivery to the end of operation. ⋯ The use of intravenous fluids and ephedrine were also comparable in the two anaesthetic groups. There was no difference in maternal or neonatal outcome. Our result supports the use of spinal anaesthesia in preeclamptic women.
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Int J Obstet Anesth · Jan 2003
Regional blockade for delivery in women with scoliosis or previous spinal surgery.
We conducted a prospective observational study between 1992 and 2001 identifying obstetric patients with untreated or surgically corrected scoliosis or lumbar-sacral fusion surgery. The regional techniques for labour and delivery that were offered were epidural analgesia, combined spinal epidural anaesthesia (CSE), single shot spinal or continuous spinal anaesthesia (CSA) depending on the degree of scoliosis, previous surgery, cardio-respiratory compromise and planned mode of delivery. Forty women were included in the study, one woman with two separate deliveries, giving 41 cases for analysis. ⋯ From a total of 19 CSA techniques attempted sixteen catheters were successfully inserted and produced good analgesia or anaesthesia for vaginal or operative delivery in 12 women (63%). There was one case of post dural puncture headache following a CSA for labour and delivery. We discuss the choices available for regional anaesthetic techniques in scoliotic women and the relative merits of each.
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Lymphangioleiomyomatosis is a rare, progressive cystic pulmonary disease related to tuberous sclerosis complex, affecting almost exclusively females of childbearing age. Progression of the disease is variable but may lead to terminal respiratory failure. As the disease may be oestrogen-dependent, it can arise de novo in pregnancy or established disease may undergo exacerbation. We report on the successful labour and delivery of such a patient and present the results of an internet survey of 30 pregnancies in 15 patients worldwide with lymphangioleiomyomatosis conducted by our patient before delivery.