International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2002
Randomized Controlled Trial Clinical TrialHigh-dose diclofenac for postoperative analgesia after elective caesarean section in regional anaesthesia.
Although the use of non-steroidal anti-inflammatory drugs (NSAIDs) is well established in the postoperative setting, their use after caesarean sections is still controversial. In a randomised, double-blinded, placebo controlled study we have estimated the opioid-sparing effect of diclofenac suppositories after elective caesarean sections in spinal anaesthesia. Eighty-two women ASA class I or II scheduled for caesarean section were randomised to receive either diclofenac suppositories 100 mg or placebo every 12 h after the operation. ⋯ The average level of postoperative pain as estimated by a visual analogue scale (VAS) and a verbal scale tended to be lower in the diclofenac group, but this was not significant. There were no differences in demographic data, perioperative bleeding, side-effects or discharge time between the groups. Diclofenac suppositories 100 mg given twice daily after caesarean section are opioid sparing.
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This four-year retrospective study examined the quality of regional blockade for caesarean section. For patients having spinal anaesthesia, data were available on requirement for analgesic supplementation or conversion to general anaesthesia. In those having epidural anaesthesia, data were available only for conversion to general anaesthesia. ⋯ Of the 827 patients in whom epidural analgesia was in progress for labour and a decision was made to proceed to caesarean section, a total of 87 patients (10.5%) needed general anaesthesia. Of those (763) in whom caesarean section was started under epidural, only 17 (2.2%) were given general anaesthesia because of intra-operative pain. Although these results may fall short of best practice, they may enable the anaesthetist to give more accurate information to patients so that better informed consent can be obtained.
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Int J Obstet Anesth · Jan 2002
Spontaneous intracranial hypotension--lessons to be learned for the investigation of post dural puncture headache.
We describe a case of spontaneous intracranial hypotension in a 36-year-old woman. This condition shares many of the features of post dural puncture headache, but without a dural puncture having been performed. The aetiology and management of this rare condition are discussed. ⋯ Highlighting this condition is important, as anaesthetists are often involved in its management. In our case, radiological investigation involved the use of spiral computerised tomography to identify the site of the hole in the dura. Spiral computerised tomography is a relatively recent innovation, which may also be useful in the investigation of post dural puncture headache when the level of the puncture is unknown.
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Int J Obstet Anesth · Jan 2002
Continuous epidural analgesia with bupivacaine 0.125% or bupivacaine 0.0625% plus sufentanil 0.25 microg.mL(-1): a study in singleton breech presentation.
Epidural analgesia is the most efficient technique for labor pain relief. However, its resultant motor block might impair the mode of delivery, particularly in breech presentation where the risk of dystocia is high. In this trial, we compared bupivacaine 0.125% with a combination of a low concentration of bupivacaine (0.0625%) and sufentanil (0.25 microg.mL(-1)) both administered by continuous infusion. ⋯ Fetal/neonatal data did not differ between groups. Epidural analgesia with bupivacaine-sufentanil required fewer additional top-ups and produced less motor block than did bupivacaine 0.125%. However, there was no significant difference in mode of delivery between the two analgesic regimens.
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Int J Obstet Anesth · Oct 2001
Simulation as a training and assessment tool in the management of failed intubation in obstetrics.
Failed intubation has been a serious problem in obstetric anaesthesia in the UK. The current study was designed to assess the use of the 'ACCESS' simulator (Anaesthetic Computer-Controlled Emergency Situation Simulator) to evaluate our trainees' performance in an obstetric failed intubation setting. Using a scoring system based on our department's failed intubation drill in obstetrics, 13 junior anaesthetists were recruited for the study and all took part in the simulation exercise. ⋯ Two weeks after that, 12 of the candidates were re-tested, and 11 scored better than their first time. The results were confidential and the authors ensured all feedback was of a positive nature. The study shows that a simulator may be a useful tool for assessment of performance in a simulated emergency situation when combined with practice and formal teaching.