Abstract：
BACKGROUND:We wished to investigate the feasibility of an ultra low-dose combined spinal-epidural technique in providing surgical anesthesia for uncomplicated cesarean deliveries in a randomized, double-blind controlled trial. METHOD:Forty-four normotensive, non-obese patients were randomized to receive either intrathecal hyperbaric bupivacaine 3.75 mg (low dose group, n=22) or 9 mg (conventional group, n=22), in addition to intrathecal fentanyl 25 microg, morphine 100 microg, and epidural 1.5% lidocaine 3 mL. Sensorimotor anesthesia and hemodynamic data were assessed at 2.5-min intervals for the first 15 min. RESULTS:The maximal sensory block achieved in the low-dose group was significantly lower than that in the conventional group (median T3, [range T2-T6] vs. T2 [C2-T6], P<0.001) with a longer time taken to reach maximal sensory block. The low-dose group had less motor block, faster sensory regression to T10 dermatome and faster motor recovery to Bromage 0 (all P<0.001). The block failed to reach T6 bilaterally within 10 min in one patient in the low-dose group and two in the conventional group, with no significant difference in the need for epidural supplementation before or after delivery of the baby. The low-dose group experienced less hypotension (14% vs. 73%, P<0.001) with less ephedrine usage (0.68 vs. 17.5 mg, P<0.001). There was no difference in operating conditions and other side effects (shivering, pruritus). CONCLUSION:We conclude that this technique results in a significantly lower incidence of maternal hypotension and has a role in high-risk parturients in whom maintenance of stable hemodynamics is imperative.
journal_name
Int J Obstet Anesthjournal_title
International journal of obstetric anesthesiaauthors
Teoh WH,Thomas E,Tan HMdoi
10.1016/j.ijoa.2006.03.004subject
Has Abstractpub_date
2006-10-01 00:00:00pages
273-8issue
4eissn
0959-289Xissn
1532-3374pii
S0959-289X(06)00046-Xjournal_volume
15pub_type
杂志文章,随机对照试验abstract：:We present our own single-space method for performing combined spinal epidural anaesthesia. A spinal introducer and a Tuohy needle are sited in the same interspace. After insertion of the epidural catheter the introducer is used as a guide for a 25 gauge spinal needle. The advantages of this technique over other metho...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/0959-289x(95)82972-d
更新日期：1995-07-01 00:00:00
abstract：BACKGROUND:Postpartum depression (PPD) is the most common complication after childbirth, affecting 10-15% of women. It is associated with serious long-term consequences for the mother and family. Whether or not neuraxial labor analgesia mitigates the risk is uncertain and controversial. The purpose of this review was t...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章,评审
doi：10.1016/j.ijoa.2020.10.004
更新日期：2020-10-17 00:00:00
abstract：:Any convulsion during labour requires immediate action, but before this can occur a correct diagnosis must be made. Here we describe a case where a 'fit' was wrongly attributed to epidural analgesia. This was in fact a dystonic reaction secondary to undeclared self-medication with metoclopramide. It is therefore impor...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/0959-289x(93)90088-y
更新日期：1993-01-01 00:00:00
abstract：:Hereditary neuropathy with liability to pressure palsy (HNPP) is a rare but probably under-diagnosed disorder of peripheral nerves in which individuals suffer from repeated motor and sensory neuropathies (pressure palsies) following brief nerve compression or mild trauma. A seemingly trivial insult such as sitting or ...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1054/ijoa.2000.0828
更新日期：2001-07-01 00:00:00
abstract：:Pompe disease (Glycogen storage disease type II) leads to abnormal glycogen deposition in various vital organs resulting in multiple systemic sequelae. We present the anaesthetic management for caesarean section of a 31-year-old parturient with known Pompe disease. The parturient had symptoms and signs of respiratory ...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2007.11.001
更新日期：2008-04-01 00:00:00
abstract：BACKGROUND:Previous studies using low-dose spinal anesthesia for cesarean delivery have focused on hypotension and efficacy. This study evaluated whether, using a combined spinal-epidural technique, there was a difference in onset of anesthesia for cesarean delivery between low-dose spinal with an immediate epidural lo...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.ijoa.2013.08.009
更新日期：2014-02-01 00:00:00
abstract：BACKGROUND:Onset times and conditions for intubation after rocuronium versus suxamethonium at cesarean section have been evaluated, but no study thus far has examined the influence of these neuromuscular blocking drugs on the surgical conditions or their effect on the duration of surgery and the ease of fetal delivery....
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2019.08.005
更新日期：2020-02-01 00:00:00
abstract：:Recent work suggests that preoperative skin infiltration with local anesthetic may lead to reduced postoperative pain. We have studied this in a randomised, prospective, double-blind trial of 40 women having cesarean section under spinal anesthesia. After establishment of the spinal block, the incision line was infilt...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/0959-289x(94)90068-x
更新日期：1994-10-01 00:00:00
abstract：:The pressor response is known to be exaggerated in patients with pregnancy-induced hypertension, which can result in increased morbidity and mortality in both mother and newborn. Various pharmacological agents have been used before induction in an attempt to attenuate the adrenergic response but with varying degree of...
journal_title：International journal of obstetric anesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1054/ijoa.2001.0918
更新日期：2002-01-01 00:00:00
abstract：BACKGROUND:Failed intubation is relatively common in the obstetric patient. Overall, there has been a decline in experience of general anaesthesia in obstetrics. The level of anaesthetic preparedness in the event of a difficult obstetric intubation is unknown. METHODS:With approval from the Obstetric Anaesthetists' As...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2009.01.015
更新日期：2009-10-01 00:00:00
abstract：:The marked reduction in the number of cases related to the provision of anaesthesia, included in the triennial Reports on Confidential Enquiries into Maternal Deaths in the UK, may limit the educational value of such reports for anaesthetists in the future. The collection, analysis and reporting of untoward events rel...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/s0959-289x(96)80041-0
更新日期：1996-10-01 00:00:00
abstract：BACKGROUND:Epidural analgesia and remifentanil patient-controlled analgesia are two popular techniques for the treatment of labour pain, each with its own efficacy and toxicity. METHODS:Parturients requesting analgesia were randomly assigned to either patient-controlled intravenous remifentanil or epidural analgesia. ...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.ijoa.2015.06.003
更新日期：2015-11-01 00:00:00
abstract：:We report a case of akathisia developed after administration of 2.5 mg metoclopramide for treatment of nausea during cesarean section. The relevant literature as well as options for prevention and treatment of this phenomenon are reviewed. ...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1054/ijoa.1999.0346
更新日期：2000-04-01 00:00:00
abstract：:Anaphylactoid reaction to Syntocinon is rare, but has been described in the literature. The reactions described include patchy erythema, hypotension, bronchospasm and oxygen desaturation, but pulseless electrical activity following Syntocinon has not been reported. We present the case of a 34-year-old primigravida wit...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2008.09.004
更新日期：2009-01-01 00:00:00
abstract：INTRODUCTION:Accurately predicting cesarean delivery case duration is an integral component of designing appropriate workflow protocols and ensuring adequate provider availability. Our primary objective was to describe the variability of case duration, based on factors that we hypothesized would be influential, such as...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2018.01.002
更新日期：2018-05-01 00:00:00
abstract：:We present two cases in which anesthesia was needed for the reduction of uterine incarceration. The first case was managed with a combined spinal/epidural technique and the second with a single intrathecal injection of opioid and low dose local anesthetic. The anesthetic issues pertinent to the reduction of an incarce...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/s0959-289x(99)80013-2
更新日期：1999-04-01 00:00:00
abstract：BACKGROUND:Post-dural puncture headache following trauma to the dural membrane during neuraxial anaesthesia occurs in 0.13-6.5% of pregnant patients. Identifying factors beyond individual performance that contribute to this adverse event is crucial to developing improvement strategies. METHODS:We used a root cause ana...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2018.05.007
更新日期：2018-11-01 00:00:00
abstract：BACKGROUND:This systematic review and meta-analysis evaluates evidence for seven risk factors associated with failed conversion of labor epidural analgesia to cesarean delivery anesthesia. METHODS:Online scientific literature databases were searched using a strategy which identified observational trials, published bet...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章,meta分析,评审
doi：10.1016/j.ijoa.2012.05.007
更新日期：2012-10-01 00:00:00
abstract：BACKGROUND:Eclampsia is a life-threatening complication of pregnancy. Timely blood pressure assessment and administration of magnesium sulphate are essential management. In this retrospective single-centre study we examined the timing and magnitude of maternal blood pressure before eclampsia, and whether magnesium sulp...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2015.01.007
更新日期：2015-08-01 00:00:00
abstract：:Acute lung disease may originate in pregnancy because of the pregnancy itself or because of an intercurrent etiology. The purpose of this study was to describe the effect of prolonged antepartum mechanical ventilatory support on the mother and the neonate when the strategy was to prolong the pregnancy rather than deli...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2006.10.015
更新日期：2007-07-01 00:00:00
abstract：BACKGROUND:Clinically overt infections of the epidural catheter skin entry site occur in approximately 1-5% of patients after a few days of catheterization but serious complications such as deep tissue infection or epidural abscess appear rare in the obstetric population. In recent years, sporadic reports and small ser...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2009.06.001
更新日期：2010-01-01 00:00:00
abstract：INTRODUCTION:The 2000-2002 triennial UK Report on Confidential Enquiries into Maternal Deaths concluded that over 50% of maternal deaths involved substandard care and that many could have been prevented. Catastrophic events leading to cardio-respiratory arrest may necessitate the resuscitation of pregnant women in vari...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2007.10.002
更新日期：2008-01-01 00:00:00
abstract：BACKGROUND:We investigated the correlation between lumbar epidural analgesia onset time and pain intensity at 60 and 120 min after initiation. METHODS:We conducted a prospective observational study of nulliparous women receiving lumbar epidural analgesia (initial bolus 15 mL bupivacaine 0.1% with fentanyl 3.33 μg/mL),...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2019.05.008
更新日期：2019-11-01 00:00:00
abstract：:Velocardiofacial or 22q11 deletion syndrome is a genetic condition caused by deletion 22q11, the deletion of a small segment of the long arm of chromosome 22. To our knowledge this is the first case report of a woman with Velocardiofacial syndrome presenting in late pregnancy for caesarean delivery. She had undergone ...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2010.12.007
更新日期：2011-07-01 00:00:00
abstract：BACKGROUND:Early studies suggested that ropivacaine had clinical advantages over bupivacaine with respect to cardiotoxicity and motor block, and that it was suitable for epidural caesarean section. This study was set up to compare epidural 0.75% ropivacaine with a popular bupivacaine/fentanyl mixture for elective caesa...
journal_title：International journal of obstetric anesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/j.ijoa.2005.01.002
更新日期：2005-07-01 00:00:00
abstract：:Gastro-oesophageal reflux (GOR) and regurgitation were investigated with an oesophageal pH electrode, inserted after the induction of general anaesthesia with methohexitone, in 100 patients undergoing termination of pregnancy, 50 in the first trimester and 50 in the second. GOR occurred in 17 patients, 8 in the first ...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/0959-289x(92)90015-v
更新日期：1992-05-01 00:00:00
abstract：:Clinical hyperthyroidism is found in approximately 5% of women with a hydatidiform mole, as human chorionic gonadotropin secreted by molar tissue is structurally similar to thyroid-stimulating hormone. A hydatidiform mole occasionally presents with a co-existing viable fetus. Surgical evacuation may be indicated for s...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2006.12.004
更新日期：2007-10-01 00:00:00
abstract：:Cystic fibrosis affects 1 in 1600-2500 live births and is inherited in an autosomal recessive manner. It primarily involves the respiratory, gastrointestinal and reproductive tracts, with impaired clearance of, and obstruction by, increasingly viscous secretions. Severe respiratory disease, diabetes and gastro-oesopha...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2013.10.006
更新日期：2014-02-01 00:00:00
abstract：: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...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/0959-289x(94)90229-1
更新日期：1994-07-01 00:00:00
abstract：:Patients with dystrophia myotonica requiring caesarean section pose significant problems for the anaesthetist. This report describes the successful use of a combined spinal-epidural technique for anaesthesia and postoperative analgesia in such a patient. ...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/s0959-289x(96)80051-3
更新日期：1996-10-01 00:00:00
