International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 1997
Adequacy of information and acceptability of pain relief as assessed by a postpartum questionnaire.
An audit cycle has been completed looking at the availability of information about different types of anaesthesia in labour, their usage and the degree of maternal satisfaction. The initial audit 7 years ago led to the production of an information leaflet on pain relief in labour. ⋯ The leaflet may have helped improve satisfaction and selection of analgesia in primigravide. However, the leaflet needs updating to include some information on caesarean section now that this has become such a common form of delivery.
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Int J Obstet Anesth · Oct 1997
Patients' assessment of sensory levels during epidural analgesia in labour.
Thirty women in established labour and with epidurals in situ were asked to assess the sensory level of the epidural using loss of light touch sensation with their own finger. This dermatomal level was then compared to the sensory level assessed by an anaesthetist using loss of cold sensation with ethyl chloride spray. ⋯ The mean dermatomal difference was 0.20 and 95% of the differences lay between 3.5 and -3.1 dermatomes. This large variation in dermatomal differences between the two methods of sensory assessment means that patient light touch is not an acceptable method of assessing epidural sensory level when compared to ethyl chloride.
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Int J Obstet Anesth · Oct 1997
Randomized Controlled Trial Clinical TrialA double-blind assessment of the analgesic sparing effect of intrathecal diamorphine (0.3 mg) with spinal anaesthesia for elective caesarean section.
In a randomized double-blind study, 40 healthy women undergoing elective caesarean section with spinal anaesthesia received either 0.3 mg diamorphine or saline with bupivacaine 0.5% in 8% dextrose. The study recorded time to the first morphine demand delivered by patient-controlled analgesia (PCA), and total morphine requirement over 24 h. In addition pain, sedation, and pruritus were assessed by non-graduated visual analogue scores (VAS). ⋯ The medians (interquartile ranges) were 5 (0, 36) mg vs 45 (26, 72) mg (P 0.0045, 95% confidence interval for the difference between the medians is 12 to 46 mg). In the diamorphine group, postoperative VAS for pain was significantly lower at 2 h and 3 h both at rest (P 0.0003, 0.003) and on moving (P 0.009, 0.002), at 8 h on moving (P 0.01), and at 12 and 24 h at rest (P 0.005, 0.029). Significantly more women suffered pruritus in the diamorphine group for the first 12 h after surgery (P 0.01).
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Int J Obstet Anesth · Oct 1997
Randomized Controlled Trial Clinical TrialNalmefene or naloxone for preventing intrathecal opioid mediated side effects in cesarean delivery patients.
This study was designed to evaluate the efficacy of nalmefene vs. naloxone in preventing side effects resulting from intrathecal opioids, in patients undergoing cesarean delivery. Eighty patients who were scheduled for elective cesarean delivery under spinal anesthesia were included in a double-blind, placebo-controlled study. ⋯ There was a significant difference among the groups with respect to the occurrence of vomiting (P < 0.03): both nalmefene groups had a higher rate of vomiting than did the control group; the 0.25 microg.kg(-1) nalmefene group had a higher rate than did the naloxone group. The use of narcotic antagonists does not result in improved comfort in obstetrical patients receiving intrathecal morphine and fentanyl.
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Pregnant patients with varicella infections have an increased risk of life threatening pulmonary complications. Prompt diagnosis and aggressive early therapy with acyclovir are important aspects of treating varicella pneumonia. ⋯ Preoperative evaluation of pulmonary function and choice of anesthetic are critical to intraoperative management. This paper presents the successful treatment of varicella pneumonia in the third trimester of pregnancy with survival of both mother and infant.