International journal of obstetric anesthesia
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It is recommended that a cricoid pressure (force) of 40 N should be applied to prevent regurgitation. The tolerance of incremental levels of cricoid pressure was assessed in 22 conscious volunteers. Each level of cricoid pressure was applied for 20 s using a cricoid yoke. ⋯ Nine subjects complained of breathing difficulties at cricoid forces of 35 N or above; 2 had complete airway obstruction. A, cricoid force of over 20 N is likely to be poorly tolerated by the awake patient. It is recommended that a force of 20 N should be maintained before loss of consciousness and the full force of 40 N be reserved for the onset of general anaesthesia; the assistant can practise these levels on a set of weighing scales.
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Int J Obstet Anesth · Sep 1992
Successful cardiopulmonary resuscitation of a parturient with amniotic fluid embolism.
A case of presumed amniotic fluid embolism is presented. Diagnosis is based on clinical findings in a 21-year-old parturient, who was admitted to hospital at 39 weeks gestation. During labor the patient became dyspneic and cyanotic, had convulsions and finally suffered a cardiac arrest. ⋯ Following delivery of the baby the heart rhythm returned to normal. The prolonged resuscitation produced serious neurological sequelae in both mother and infant in the first few months following delivery, though with complete long-term recovery. This case report highlights the importance of displacing the uterus laterally and performing an emergency cesarean section during resuscitation.
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Int J Obstet Anesth · May 1992
Spinal or epidural anaesthesia for elective caesarean section? A Swedish experience.
Ninety seven women undergoing elective lower segment caesarean section were randomly divided into two groups, group 1 received spinal anaesthesia with hyperbaric bupivacaine and group 2 received mepivacaine 20 mg/ml with adrenaline 5 microg/ml via an epidural catheter. All patients were given a preload of Ringer acetate and Macrodex prior to onset of anaesthesia. Ephedrine 5 mg was given if the systolic blood pressure fell below 100 mmHg. ⋯ The Apgar scores at 1 and 5 min were similar in both groups. The results from our study suggest that spinal anaesthesia is a good alternative to epidural anaesthesia for elective caesarean section. A fall in blood pressure, which is equally possible in both groups of patients, should be prevented by adequate fluid preload and treated immediately by intravenous ephedrine.
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Int J Obstet Anesth · May 1992
Ephedrine and phenylephrine for avoiding maternal hypotension due to spinal anaesthesia for caesarean section. Effects on uteroplacental and fetal haemodynamics.
The effects of i.v. vasopressors on Doppler velocimetry of the maternal uterine and placental arcuate arteries and the fetal umbilical, renal and middle cerebral arteries were studied during spinal anaesthesia in 19 healthy parturients undergoing elective caesarean section. Fetal myocardial function was investigated at the same time by M-mode echocardiography. The patients were randomized into two groups, to be given either ephedrine or phenylephrine as a prophylactic infusion supplemented with minor boluses if systolic arterial pressure decreased by more than 10 mmHg from the control value. ⋯ The ephedrine group showed no significant differences in any of the Doppler velocimetry recordings relative to the baseline values, but during the phenylephrine infusion the blood flow velocity waveform indices for the uterine and placental arcuate arteries increased significantly and vascular resistance decreased significantly in the fetal renal arteries. Healthy fetuses seem to tolerate these changes in uteroplacental circulation well, however, since the Apgar scores for the newborns and the acid-base values in the umbilical cord were within the normal range in both groups. The results suggest that some caution is required when selecting the specific vasopressor agent, the dosage and the mode of administration for the treatment of maternal hypotension secondary to spinal anaesthesia for caesarean section.
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Int J Obstet Anesth · Jan 1992
The effectiveness of low dose droperidol in controlling nausea and vomiting during epidural anesthesia for cesarean section.
The antiemetic efficacy of 0.5 mg of droperidol was evaluated in 128 term parturients undergoing elective and non-urgent cesarean section with epidural anesthesia. Following delivery, parturients received intravenously either 0.5 mg of droperidol or normal saline in a double-blinded fashion. Droperidol decreased nausea after delivery from 41 to 13% (P=0.001). ⋯ Analysis of the data using logistic regression analysis showed that increasing age (P = 0.002), hypotension after delivery (P = 0.040), and vomiting prior to delivery (P = 0.017) were associated with increased nausea after delivery. No extrapyramidal symptoms or significant changes in pulse rate or blood pressure were associated with droperidol administration. We conclude that 0.5 mg of intravenous droperidol decreases nausea in term parturients undergoing non-urgent cesarean section with epidural anesthesia without producing unwanted side-effects.