International journal of obstetric anesthesia
-
Int J Obstet Anesth · Apr 1997
Randomized Controlled Trial Clinical TrialA comparison of catheter vs needle injection of local anesthetic for induction of epidural anesthesia for cesarean section.
It is generally believed that bolus injections of local anesthetic through an epidural needle produce a more rapid onset of blockade, but at the expense of an increased incidence and severity of hypotension, whereas intermittent injections through a catheter take longer to achieve adequate anesthesia but with a lower risk of hypotension. The present study investigated two commonly used needle and catheter epidural injection techniques for differences in speed of onset of surgical anesthesia and incidence and severity of hypotension. ⋯ No significant difference was found for the time to onset of surgical anesthesia. In the absence of benefits of needle injection, incremental catheter administration of local anesthetic with its multiple safety advantages is the technique of choice for induction of epidural anesthesia for cesarean section.
-
Int J Obstet Anesth · Apr 1997
Randomized Controlled Trial Clinical TrialAnalgesia after caesarean section: patient-controlled intravenous morphine vs epidural morphine.
In a randomized, double-blind study, conducted in 60 patients after caesarean section, we compared epidural morphine (5 mg) with intravenous morphine patient-controlled analgesia (PCA). Efficacy of pain relief (visual analogue scale), comfort, satisfaction and side-effects were studied. In the PCA group, pain scores were higher (P < 0.005) from the third hour onward. ⋯ Consumption of morphine was higher in the PCA group. We conclude that epidural morphine analgesia, though of good quality, was associated with more pruritus. Morphine PCA, although producing a lesser degree of analgesia compared to epidural morphine, gave good satisfaction.
-
Int J Obstet Anesth · Apr 1997
Cardiac arrest complicating spinal anaesthesia for caesarean section.
We present a 36-year-old multiparous woman who developed intractable hypotension and cardiac arrest during spinal anaesthesia for elective caesarean section. Cardiopulmonary resuscitation was successful and both mother and baby made a good recovery. Postoperative investigation revealed a dilated cardiomyopathy related to pregnancy. This case highlights the importance of expediting delivery of the neonate during maternal cardiopulmonary resuscitation, the prompt use of adrenaline as inotropic support, and preoperative assessment in apparently healthy parturients.
-
Int J Obstet Anesth · Apr 1997
Anesthesia for combined cesarean section and extra-adrenal pheochromocytoma resection: a case report and literature review.
Pheochromocytoma during pregnancy is unusual, with approximately 250 cases now reported in the literature. The current case describes the anesthetic management of a patient with a large extra-adrenal pheochromocytoma who underwent a combined cesarean section and tumor removal in which perioperative hemodynamic control was difficult despite high-dose a-adrenergic blockade. ⋯ Established criteria exist for the adequacy of alpha- and beta-adrebergic blockade for the management of pheochromocytoma in the non-pregnant patient. We discuss how these criteria apply to pregnant patients with pheochromocytoma, and suggest possible modifications to the criteria.