Articles from International journal of obstetric anesthesia

Int J Obstet Anesth · Oct 1999

Randomized Controlled Trial Clinical Trial

Oxford positioning technique improves haemodynamic stability and predictability of block height of spinal anaesthesia for elective caesarean section.

A novel positioning technique was tested to see whether the unpredictability of block height and haemodynamic instability during spinal anaesthesia for caesarean section could be reduced. In this 'Oxford' position, the woman is placed left lateral with an inflated bag under the shoulder and pillows supporting the head. Following spinal injection the woman is turned to an identical right lateral position. ⋯ Block height was more variable in group S than in group O (f test, P = 0.001). Blood pressure decreased by a greater amount initially: group S women required more ephedrine (15.5 +/- 12.9 versus 9.2 +/- 7.7 mg, t test, P = 0.03). Block height with spinal anaesthesia for caesarean section is more predictable and haemodynamically stable if the Oxford position is used whilst anaesthesia develops.

Comparison of epidural lidocaine and fentanyl to intrathecal sufentanil for analgesia in early labour.

A randomized, double-blind study was undertaken comparing an epidural test dose of lidocaine followed by 100 microg fentanyl (E-LF, n = 19) to combined spinal epidural sufentanil 10 microg (CSE-S, n = 21) in low risk women in early labour. The primary outcome measured was the duration of analgesia; secondary outcomes included the quality of analgesia, incidence and severity of pruritus, lower limb motor blockade, and the ability to ambulate. A P < 0.05 was considered statistically significant. ⋯ The VAS for pruritus were higher in the CSE-S group (P < 0.05) but no patient requested treatment for pruritus. Mild motor weakness was more frequent in the E-LF group (5/19 versus 20/21, P < 0.05) and fewer patients in the E-LF group met criteria for ambulation (13/19 versus 20/21, P < 0.05). While both E-LF and CSE-S provide effective analgesia for women in early labour, the more rapid onset of analgesia, lower VAS pain scores, longer duration of action and lesser impact on ability to ambulate suggest advantages of CSE-S over E-LF.

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Int J Obstet Anesth · Oct 1999

Benign intracranial hypertension and anaesthesia for caesarean section.

Benign intracranial hypertension (idiopathic hypertension, pseudomotor cerebrii) describes the syndrome of elevated intracranial pressure without clinical, laboratory or radiological evidence of a focal lesion. Unlike conditions where intracranial pressure is raised due to a space-occupying lesion, dural puncture is not contraindicated. In this report we describe the delivery by caesarean section of a parturient with this rare condition using the needle through needle combined spinal-epidural technique.