International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 1994
Spinal anaesthesia for caesarean section following epidural analgesia in labour: a relative contraindication.
Three cases are described in which epidural analgesia was performed during labour using an infusion of bupivacaine 0.125-0.25%. When, in all 3 cases, caesarean section was required for failure to progress, hyperbaric bupivacaine was given in doses of 10 mg, 12.5 mg and 15 mg respectively. Within 2-4 min all 3 patients had a high block, complained of difficulty in breathing and subsequently developed apnoea. ⋯ All three mothers remain in good health and do not regret having had spinal anaesthesia for caesarean section. In contrast to previously reported cases of high spinal anaesthesia following unsuccessful epidural anaesthesia for caesarean section, this report describes 3 cases of high spinal following the administration of spinal anaesthesia upon an ongoing epidural infusion of local anaesthetic during labour. As no guidelines are available as to the recommended dose of spinal anaesthetic under such circumstances and, in view of the several case reports describing a similar complication under different circumstances, we suggest that spinal anaesthesia is contraindicated upon ongoing epidural analgesia or following a failed epidural.
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Int J Obstet Anesth · Jul 1994
Anesthetic management of a parturient with mixed mitral valve disease and uncontrolled atrial fibrillation.
This case report describes the anesthetic management of a 32-year-old parturient with combined severe mitral regurgitation and moderate mitral stenosis, complicated by fast atrial fibrillation. The advantageous effects of epidural analgesia during labor and vaginal delivery and the importance of invasive monitoring are discussed. We also report the rare complication of right bundle branch block related to the use of a pulmonary artery catheter.
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Int J Obstet Anesth · Jul 1994
Acid aspiration prophylaxis in 202 obstetric anaesthetic units in the UK.
A postal survey of obstetric anaesthetic units in the UK was conducted by questionnaire to gain information about current acid aspiration prophylaxis. Information regarding the delivery rate and the caesarean section rate under regional techniques was also requested. ⋯ Sodium citrate and the H(2) antagonist ranitidine remain the drugs most commonly used for acid aspiration prophylaxis. However, the number of departments carrying out routine prophylaxis for patients in active labour has fallen from 75% in 1988 to 57% in the current survey.
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A modification to a computer based system of audit, widely used in anaesthesia for general surgery, is described, which permits a more detailed analysis of obstetric anaesthetic workload. By adjusting entries, in the operation input field, further information can be collected automatically. ⋯ It identifies the total number of caesarean sections, including anaesthetic technique and whether an epidural catheter was, in any case, present. This modification may be applicable to other computerised audit systems.