International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 1996
Randomized Controlled Trial Clinical TrialThromboembolic deterrent stockings fail to prevent hypotension associated with spinal anaesthesia for elective caesarean section.
This study was carried out to determine whether the use of thrombo-embolic deterrent (TED) stockings, in combination with an intravenous crystalloid preload, would prevent hypotension following spinal anaesthesia for caesarean section. Fifty parturients undergoing elective caesarean section under spinal anaesthesia were randomly allocated into two groups. TED stockings were applied to the study group 1 h before spinal anaesthesia but none were applied to the control group. ⋯ Significant hypotension, defined as an absolute value of systolic arterial pressure (SAP) of less than 90 mmHg and a decrease of more than 20% from baseline SAP was treated with 3 mg bolus of ephedrine as required. The difference in SAO between the two groups was not statistically significant. In the control group, 80% of parturients required ephedrine as opposed to 56% in the TED group; a difference that was also not statistically significant.
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Routine orogastric aspiration of stomach contents during general anaesthesia for caesarean section was recommended in the latest triennial report on maternal deaths. We conducted a postal survey which revealed that the majority of obstetric units do not follow this guideline. ⋯ Despite routine antacid prophylaxis, a large proportion of our emergency patients remain at risk for aspiration pneumonia. We thus concur with the recommendation that the stomach should be aspirated during general anaesthesia for emergency caesarean section.
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Occupational exposure to nitrous oxide may be increased in confined working environments where ventilation and scavenging are either ineffective or unavailable. This is particularly the case on the labour ward. To assess the exposure of midwives working on the labour ward, midwives were asked to wear personal nitrous oxide samplers during their shift periods. ⋯ Fifty-six (23%) had NZO levels over 100 ppm and 129 (53%) had levels above 25 ppm. During the 111 midwife shift periods where midwives did not work in a room where Entonox was in use, their mean exposure was 22 ppm (median 12 ppm), however in four of these midwife shift periods the mean exposure level exceeded 100 ppm. Chronic exposure to high levels of nitrous oxide which exceed the recently proposed UK standard of 100 ppm and those in force in the USA (25 ppm) and Sweden (100 ppm) are frequently encountered by midwives.
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Int J Obstet Anesth · Jul 1996
Anaesthetic management of labour in two patients with Klippel-Feil syndrome.
Two patients with Type I Klippel-Feil syndrome presented at the antenatal clinic. The first patient, who suffered from sleep apnoea, was delivered of a healthy infant by vacuum extraction. ⋯ In both cases epidural analgesia was employed to allow pain relief during labour. Anaesthetic management of Klippel-Feil syndrome is discussed and the benefits of early anaesthetic assessment and continued involvement of senior anaesthetic and obstetric staff emphasized.