International journal of obstetric anesthesia
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The cardiovascular changes during epidural caesarean delivery were studied, using a non-invasive cardiac output monitor (BoMed NCCOM3-R7). Two different regimens were used to control hypotension (A = 15 ml/kg of 3% dextran 70, B = 7.5 ml/kg of 3% dextran 70 followed by an infusion of 17.5 mg of ephedrine). ⋯ The increase in cardiac output after delivery was greater than that measured previously, which might be because impedance cardiac output is a continuous method. It is also suggested that the most pronounced changes are augmented by the use of a bolus injection of 10 units oxytocin i.v.
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Int J Obstet Anesth · Jan 1994
Acute tissue damage following epidural cannulation: a comparison between the midline and paramedian approach in obstetric patients.
Forty obstetric patients were randomly allocated to receive either a midline or paramedian approach to the epidural space using loss of resistance to air. Tissue trauma was assessed by blinded observers, clinically by the presence of pain and radiologically using magnetic resonance imaging (MRI). ⋯ There was no significant difference in localized back pain between the two groups, and this was not related to MRI findings. Pain did not persist for more than 4 days.
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Int J Obstet Anesth · Jan 1994
The use of a paraspinal field block before epidural analgesia for labour.
The purpose of this study was to determine whether paraspinal field block (PSFB) reduced the pain of epidural needle insertion and the incidence of prolonged post partum back pain in patients receiving epidural analgesia for labour. Patients were randomly assigned to receive local infiltration only with 1-1.5 ml of 1.5% lidocaine (group C, N = 27) or PSFB consisting of an additional 1 ml of 1.5% (group S, N = 30) through the midline skin wheal, on either side of the midline (total 2 ml), near the lamina, before needle insertion. Back pain was measured at the time of needle insertion, before discharge from hospital and 6 weeks post partum, by a blinded observer. ⋯ The cause of post partum back pain is multifactorial and is not dependent on technique of epidural insertion. We conclude that PSFB is ineffective in reducing the pain of epidural needle insertion in labouring patients. Although this study was too small to detect a difference in incidence of late post partum back pain, it appears to be less common than previously reported.
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Int J Obstet Anesth · Jan 1994
A survey of coagulation screening practices in preeclampsia and low-dose aspirin prophylaxis.
In a postal survey of 47 hospitals, consultant anaesthetists were asked their policies for investigating coagulation in parturients with preeclampsia and for those taking aspirin prophylaxis. There was some agreement over policies for mild to moderate preeclampsia. The study also showed that significant numbers of the smaller units encountered aspirin treatment but that there was little consensus on how to respond to it.