Article Notes
- Successful catheter insertion on first attempt in 47%
- Satisfactory and uncomplicated analgesia in 55%.
- Dural puncture in 4%.
- Subdural catheterization in 4%.
A case report and brief literature review examining the efficacy and complications of labor epidural analgesia in patients with Harrington rods after scoliosis surgery.
Ho, Ngan Kee & Chung reviewed 52 reported cases in the literature showing:
Lowest success rates, highest repeated-attempts and highest complication rates (DP 8%, failure 8%, poor analgesia 55%) occurred in those with a spinal surgery scar extending below the epidural insertion point.
Daniel Jolley
Articles of interest relevant to labor epidural analgesia, both specifically focusing on obstetric epidurals and more peripherally relevant to obstetric labor analgesia.
Daniel Jolley
An interesting narrative focusing on John Snow's successful introduction of anesthesia, particularly chloroform, to obstetric practice in the 19th century.
The paper begins with a brief exploration of why James Young Simpson, arguably the first pioneer of obstetric anesthesia, failed to popularize this new technology when shortly thereafter Snow succeeded.
Daniel Jolley
Papers focusing on the history of anesthesia – both modern articles and the original historical, landmark articles themselves.
Daniel Jolley
This follow-up paper to the original COMET study describes in detail the high and low-dose epidural techniques and the subsequent anesthetic characteristics.
The low-dose techniques used infusions of 0.1% bupivacaine with 2 mcg/mL fentanyl, compared with 10mL boluses of 0.25% bupivacaine. Maternal analgesia experience was similar between the groups, all the CSE group experienced better analgesia in the first hour.
Daniel Jolley
The COMET trial was a landmark study demonstrating the benefit on mode of delivery of using either a low-concentration (0.1% bupivacaine + 2mcg/mL fentanyl) epidural infusion or a combined spinal-epidural technique, over a traditional high-dose (10mL boluses of 0.25% bupivacaine) epidural.
Vaginal delivery rate was significantly higher in the low-dose (OR 1.38) and CSE (OR 1.39) groups than in the traditional high-dose group.
Daniel Jolley
A collection of landmark research articles relevant to obstetric anesthesia. Some, such as Hawkins' audits of U.S. maternal deaths, are significant because of their historical impact. Others hold direct clinical relevance for practice today.
Daniel Jolley
This follow-up paper to Hawkin's original "Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990" showed a dramatic improvement in the relative risk of cesarean section death with general vs regional anesthesia compared with the original 1979-1990.
Where previously (1979-1990) the relative risk of death during GA CS was 16.7, from 1997-2002 the relative risk had fallen to 1.7. Worryingly though this was both due to a falling mortality rate for GA CS and an increasing mortality rate for regional anesthesia CS.
Cesarean section under general anesthesia still exposes mothers to an increased risk of perioperative death, but this risk is much lower than previously, likely due to better anesthesia training, supervision and respect of the obstetric airway.
Daniel Jolley