Articles: outcome.
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Int J Obstet Anesth · Oct 1999
Randomized Controlled Trial Clinical TrialComparison of epidural lidocaine and fentanyl to intrathecal sufentanil for analgesia in early labour.
A randomized, double-blind study was undertaken comparing an epidural test dose of lidocaine followed by 100 microg fentanyl (E-LF, n = 19) to combined spinal epidural sufentanil 10 microg (CSE-S, n = 21) in low risk women in early labour. The primary outcome measured was the duration of analgesia; secondary outcomes included the quality of analgesia, incidence and severity of pruritus, lower limb motor blockade, and the ability to ambulate. A P < 0.05 was considered statistically significant. ⋯ The VAS for pruritus were higher in the CSE-S group (P < 0.05) but no patient requested treatment for pruritus. Mild motor weakness was more frequent in the E-LF group (5/19 versus 20/21, P < 0.05) and fewer patients in the E-LF group met criteria for ambulation (13/19 versus 20/21, P < 0.05). While both E-LF and CSE-S provide effective analgesia for women in early labour, the more rapid onset of analgesia, lower VAS pain scores, longer duration of action and lesser impact on ability to ambulate suggest advantages of CSE-S over E-LF.
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Int J Obstet Anesth · Oct 1999
Anaesthetic management of parturients with the antiphospholipid syndrome: a review of 27 cases.
A description of antiphospholipid syndrome (APS) and associated maternal and fetal complications is presented along with a review of the management at National Women's Hospital (NWH), Auckland, of 27 pregnancies complicated by APS. Because the obstetric outcome for parturients with APS continues to improve, anaesthetists are more likely to become involved in their management. It is recommended that policies and protocols are implemented to avoid unnecessary denial of regional anaesthesia arising from confusion about any parturients anticoagulation status.
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Int J Obstet Anesth · Jul 1999
A patient who was found to be pregnant unexpectedly during hysteromyomectomy.
We present a case of an unexpected pregnancy and an ultimately successful obstetric outcome. The patient underwent abdominal myomectomy under spinal anaesthesia for a uterine leiomyoma with menorrhagia and infertility. ⋯ The blastocyst survived the surgical manipulation and anaesthesia, resulting in a successful pregnancy. The literature on the endocrinological stress response during anaesthesia and surgery suggests that spinal anaesthesia administered in this case was potentially helpful in maintaining progesterone levels and avoiding increased prolactin levels; increased prolactin levels might be deleterious to implantation of the blastocyst.
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Objective. To evaluate effectiveness of spinal cord stimulation (SCS) applied to complex regional pain syndrome I (CRPS I). To analyze trends to focus the design of a multicenter prospective study. ⋯ Frequencies > 250Hz were necessary in some patients to maintain or re-establish pain control. Bilateral multielectrode leads appear superior with application of multiple arrays, permitting paresthesia steering without need for surgical revision. A multicenter, prospective design is needed applying dual-lead multichannel systems with high frequency capabilities in the treatment of CRPS I.