International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 1998
Randomized Controlled Trial Clinical TrialComparison of three different loading doses to establish epidural analgesia in labour.
Women requesting epidural analgesia were randomized to receive one of three loading doses. Group 1 received a single dose of bupivacaine 9.375 mg (15 ml of 0.0625%) containing fentanyl 37.5 microg and adrenaline 37.5 microg group 2 received a single dose of bupivacaine 15 mg (15 ml of 0.1%) containing fentanyl 30 microg and adrenaline 30 microg and group 3 received a test dose of bupivacaine 10 mg (4 ml of 0.25% - test) followed 5 min later by bupivacaine 20 mg (8 ml of 0.25% - loading). ⋯ Speed of onset of analgesia was the same in all three groups, with the majority of women achieving satisfactory analgesia by 20 min. Motor block was significantly increased in group 3 at 30 min, but by 1 h there was no difference in motor block between the groups.
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Day case transvaginal ultrasound-guided needle puncture is currently the method of choice for oocyte retrieval. The risk of morbidity from this procedure increases with sudden patient movement in response to needle manipulation. ⋯ The aim of this pilot study was to establish whether spinal analgesia using a mixture of bupivacaine and fentanyl could be useful in this context. The results identify several advantages of this technique over current clinical practice, and merit further comparative investigation.
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Int J Obstet Anesth · Jul 1998
Randomized Controlled Trial Clinical TrialThe effect of early epidural block administration on the progression and outcome of labor.
This study was undertaken to prospectively evaluate the effect of early administration of epidural bupivacaine (0.25%) on the progression and outcome of labor in 60 nulliparous patients. Patients were randomly divided into two groups. ⋯ There were no statistically significant differences between the two groups in rate of cervical dilatation, duration of the second stage, numbers of instrumental deliveries or cesarean sections or Apgar scores at 1 and 5 min. We conclude that there is no need to restrict epidural top-ups until cervical dilatation of 4 cm, when active management of labor is advocated.
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Int J Obstet Anesth · Jul 1998
General anesthesia for cesarean section at a tertiary care hospital 1990-1995: indications and implications.
Complications of general anesthesia for cesarean section remain the leading cause of anesthesia-related maternal mortality. General anesthesia, however, is becoming less popular for obstetric anesthesia, and thus fewer cesarean sections are conducted using this technique. As the number of general anesthesia cases decrease, the number of difficult intubations witnessed and managed by residents decreases. ⋯ Although the incidence of difficult intubations in those years ranged from 16.3% to 1.3%, only one failed intubation with resultant maternal mortality occurred. Few residency programs offer instruction on the difficult airway in the parturient population. Organized airway management programs specifically for the obstetric population may assist efforts to decrease the morbidity and mortality associated with the provision of general anesthesia for cesarean section.
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Int J Obstet Anesth · Jul 1998
Randomized Controlled Trial Clinical TrialAlternating patient position following the induction of obstetric epidural analgesia does not affect local anaesthetic spread.
To assess the influence of gravity on epidural-induced sensory blockade during the first stage of labour, 60 parturients were recruited to a randomized, controlled, single-blinded study. In all cases an epidural catheter was placed with the patient in the left lateral position. Thereafter, patients were randomized to one of three groups. ⋯ Time to maximal block was 14.7 +/- 2.3 min, 14.1 +/- 1.6 min and 13.9 +/- 1.5 min for groups L, L+R and S respectively. After maximal blockade, pain scores were significantly (P<0.0001) decreased in all groups, with no differences between them. We conclude that position immediately following local anaesthetic drug administration has little effect on onset and distribution of epidural analgesia.