International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2001
Randomized Controlled Trial Clinical TrialEffect of lateral versus supine wedged position on development of spinal blockade and hypotension.
Aortocaval compression may not be completely prevented by the supine wedged or tilted positions. It is commonly believed, however, that the unmodified full lateral position after induction of spinal anaesthesia might allow excessive spread of the block. We therefore compared baseline arterial pressures in the supine wedged, sitting, tilted and full lateral positions in 40 women who were about to undergo elective caesarean section. ⋯ Following spinal anaesthesia, hypotension (defined as a reading
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Int J Obstet Anesth · Jul 2001
An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients.
We report a prospective audit of 100 parturients who experienced accidental dural puncture by a Tuohy needle, while attending a tertiary referral obstetric unit during the period 1993-1999. The post dural puncture headache rate was 81% and the diagnosis of dural puncture was delayed until presentation of the headache in 27% of these cases. The incidence of unrecognised dural puncture was not influenced by the technique used for identification of the epidural space. ⋯ There was a trend to earlier onset of headache (either immediate or within 24 h) when the epidural identification technique was loss-of-resistance to air rather than saline (54% versus 33%, P = 0.07). Twenty-eight percent of those suffering from post dural puncture headache were treated expectantly and 72% received a therapeutic blood patch. Of seven parturients who received sumatriptan, six found it ineffective and five subsequently received a blood patch.
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Int J Obstet Anesth · Apr 2001
Randomized Controlled Trial Clinical TrialThe use of thromboembolic deterrent stockings and a sequential compression device to prevent spinal hypotension during caesarean section.
Hypotension is a common side effect of spinal anaesthesia for caesarean section. We have performed a randomised, controlled study to determine the efficacy of a sequential compression device (SCD) (Kendall) in combination with thromboembolic deterrent (TED) stockings (Kendall) to reduce the incidence of hypotension in this setting. Within 20 min of spinal injection, there was no statistically significant difference in the incidence of hypotension (defined as less than 100 mmHg and less than 80% of baseline blood pressure) (TED/SCD group 65%, control 80%, P = 0.12). ⋯ To try to reduce the influence of this, we reinspected our data using time to first episode of hypotension with a Kaplan-Meier survival analysis. This showed that the instantaneous risk (hazard) of developing hypotension was 1.8 (95% CI: 1.1-2.9) times higher in controls than those receiving TED/SCD prophylaxis (P = 0.02). Despite demonstrating some benefit of TED/SCD prophylaxis to prevent hypotension, we do not consider that the magnitude of this benefit warrants their routine use.
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Int J Obstet Anesth · Apr 2001
The management of eclampsia by obstetric anaesthetists in UK: a postal survey.
Eclampsia and pre-eclampsia are major causes of morbidity and mortality in the obstetric population. The latest triennial report on Confidential Enquiries into Maternal Deaths found hypertensive disorders of pregnancy to be the second most common cause of maternal deaths directly attributable to pregnancy. The management of eclampsia includes the control and prevention of further convulsions by pharmacological methods but the choice of drugs may vary. ⋯ The response rate was 86%. Our results show that magnesium sulphate is used for the treatment of eclampsia in 90% of units and for severe pre-eclampsia in 68%. Most administered magnesium for 24-48 h while nimodipine was used by very few units.
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Int J Obstet Anesth · Apr 2001
Randomized Controlled Trial Clinical TrialA comparison of pethidine and remifentanil patient-controlled analgesia in labour.
We conducted a double-blind randomised controlled trial comparing the efficacy of analgesia during labour of remifentanil and pethidine. Nine women were randomised to receive an i.v. bolus of remifentanil 0.5 microg.kg(-1)with a lockout period of 2 min and eight women were randomised to receive a bolus of pethidine 10 mg with a lockout period of 5 min. A visual analogue scale (VAS) scoring system was used to assess the level of pain hourly throughout the first and second stages of labour and a score was recorded within half an hour of delivery for the level of pain overall throughout labour (post delivery score). ⋯ With the data available, we demonstrated significantly lower mean hourly and post delivery VAS scores for pain in the remifentanil group (P < 0.05). The 1 and 5 min Apgar scores were significantly lower in the pethidine group compared with the remifentanil group (P < 0.05). This preliminary study suggests that remifentanil may have a use as patient-controlled analgesia for women in labour.