International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1993
Maternal effects of adding epidural fentanyl to 0.5% bupivacaine for caesarean section.
Epidural injection of fentanyl added to 0.5% bupivacaine improves epidural anaesthesia during caesarean section. The present prospective randomized double-blind study sought to determine the lowest effective dose of fentanyl. Eighty healthy women at term were divided into four groups of 20, with each group receiving a different 2 ml study solution: saline (control) or 50, 75 or 100 microg of fentanyl added to 20 ml of 0.5% bupivacaine. ⋯ Pruritus was the only side-effect (P < 0.05). In conclusion, fentanyl 75 microg was the lowest effective dose for improving quality of analgesia. Onset time was not reduced by the addition of fentanyl.
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Forty patients in whom the dura had been punctured accidentally and 10 patients who had received spinal anaesthesia required epidural blood patching for relief of severe postdural puncture headache (PDPH). Before injecting blood, the epidural pressure was measured, using an epidural catheter as a manometer. ⋯ In 5 patients with inadvertent dural tap, there was a statistically significant decrease (P<0.02) in epidural pressure from 14.9 cm H(2)O (range 11-22 cm H(2)O) before PDPH to 6.9 cm H(2)O (range 5-8.5 cm H(2)O) when they developed PDPH. The benefits of performing an epidural blood patch through a catheter placed in the epidural space are discussed.
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Int J Obstet Anesth · Jan 1993
Haemodynamic effects of the position chosen for the insertion of an epidural catheter.
An epidural catheter may be inserted with the patient either in the flexed left lateral or the sitting position. We have studied, non-invasively, the haemodynamic changes associated with these positions, using the thoracic bio-impedance method (BOMED NCCOM3 Monitor). Maternal arterial pressure and fetal heart rate were monitored simultaneously. ⋯ These changes in SI produced significant reductions in cardiac index (CI) in both groups. In the pregnant patients the CI was significantly lower in the flexed left lateral than in the sitting position (P < 0.01). Consequently maternal systolic blood pressure was lower in the flexed left lateral position (P < 0.01).
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Aspiration is a common clinical entity whose consequences range from the relatively benign to fulminant acute respiratory failure and death. Clinical situations in which airway protection is lost or compromised predispose patients to aspiration. ⋯ When mechanical ventilatory support is required, the avoidance of iatrogenic complications, including worsening lung injury, becomes especially important. Preventative measures, either to minimize the chances of aspiration, or to reduce the potential for injury consequent to aspiration may be highly effective in reducing the incidence of aspiration syndromes.