International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1997
Clinical Trial Controlled Clinical TrialPerioperative analgesia for caesarean section: comparison of intrathecal morphine and fentanyl alone or in combination.
In a double-blind placebo-controlled trial we compared perioperative pain relief using different intrathecal opioid regimens given with bupivacaine during spinal anaesthesia for elective caesarean section. One hundred and sixteen patients undergoing elective caesarean section were divided into four groups (A, B, C, D) of 29 patients each. In addition to hyperbaric bupivacaine (12-14 mg), group A received 1 ml of normal saline, group B 25 microg of fentanyl, group C 100 microg of morphine, and group D received both fentanyl 25 microg and morphine 100 microg intrathecally. ⋯ The use of the opioids in association, however, was found to increase the incidence of side-effects. The quality of postoperative analgesia with fentanyl, when used alone, was found to be inferior to that with morphine. The combination of opioids offered no advantage over morphine alone.
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Int J Obstet Anesth · Jan 1997
Spinal anesthesia versus intravenous sedation for transvaginal oocyte retrieval: reproductive outcome, side-effects and recovery profiles.
Transvaginal ultrasonically guided oocyte retrieval is commonly performed as part of in vitro fertilization efforts. The impact of anesthetic management on patient outcome from this procedure has not been well characterized. At our institution, patients are offered a choice of either heavy intravenous sedation or spinal anesthesia with minimal or no sedatives. ⋯ The intravenous sedation group required a significantly longer period until recovery room discharge criteria were met (P = 0.03), and were more likely to have postoperative emetic episodes (46% versus 6% in the spinal anesthesia group: P < 0.01). Two unplanned hospital admissions occurred in the intravenous sedation group: both were related to uncontrolled nausea and vomiting. We conclude that spinal anesthesia may have advantages over intravenous sedation for oocyte retrieval.
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Int J Obstet Anesth · Jan 1997
Determination of the minimum local analgesic concentration of epidural chloroprocaine hydrochloride in labor.
The aim was to determine the effective concentration in 50% of patients (EC(50)) of chloroprocaine in the first stage of labor. A constant dose modification of a model where EC(50) was previously defined as the minimum local analgesic concentration (MLAC) was used. Parturients (n = 36) requesting epidural analgesia in labor, at cervical dilatation not exceeding 7 cm, were enrolled into this prospective, double-blinded study. ⋯ MLAC (95%CI) was 0.42%w/v (0.34 to 0.5) using the formula of Dixon & Massey and as a sensitivity test was 0.4%w/v (0.35 to 0.46) using probit regression analysis. In conclusion, MLAC of chloroprocaine was 0.42%w/v in these parturients, equivalent to 14 millimolar solution. This study confirmed that concentration rather than dose could be used as a measure of efficacy in this constant dose model.
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Int J Obstet Anesth · Jan 1997
Total intravenous anaesthesia for caesarean section in a patient with Marfan's syndrome.
The case is described of a pregnant patient with Marfan's syndrome scheduled at 39 weeks' gestation for elective caesarean section carried out for the first time by total intravenous anaesthesia (TIVA) with continuous intravenous (i.v.) infusion of propofol. The diagnosis was based on a positive family history, classic phenotype, scoliosis, arachnodactyly, high narrow palate, hyperextensible joints, ectopia lentis and mitral valve prolapse, with a secondary low mitral insufficiency. Maternal and fetal surveillance did not detect complications during the course of pregnancy. ⋯ Apgar scores were 9 at 1 and 5 min. The post-delivery course was unremarkable and post partum echocardiography showed no changes from before caesarean section. The cardiovascular problems of Marfan's syndrome, the risk of haemodynamic changes associated with pregnancy and delivery, its anaesthetic implications and the possible advantages of TIVA with continuous i.v. infusion of propofol in the anaesthetic management of caesarean section in patients with this disease are discussed.