Abstract：
STUDY OBJECTIVE:To analyze the effects of epidural analgesia for labor when dystocia occurs. DESIGN:Retrospective cohort study. SETTING:Academic health center. PATIENTS:641 low risk, nulliparous women in spontaneous labor. INTERVENTIONS:406 (63%) women received epidurals analgesia and 253 (37%) did not. Sixty women (9.4%) required an abdominal delivery for dystocia. MEASUREMENTS AND MAIN RESULTS:Women receiving epidural analgesia were more likely to be white, receive care from an attending physician, need labor augmentation, and deliver a heavier infant. Multivariate analysis identified five variables predictive of dystocia and abdominal delivery: pitocin augmentation odds ratio (O.R.) = 3.9 (2.0 to 7.6), duration of labor more than 20 hours O.R. = 2.4 (1.3 to 4.4), high epidural dose O.R. = 2.2 (1.2 to 4.1), birthweight over 4,000 grams O.R. = 2.0 (1.0 to 4.2), and early placement of epidural O.R. = 1. 9 (1.0 to 3.5). Repeating the regression after excluding the 20 women who developed abnormal labor prior to epidural placement (18 of 20 women had protracted dilatation) demonstrated that pitocin augmentation O.R. = 4.0 (1.8 to 4.), high epidural dose O.R. = 3.0 (1.9 to 6.2), duration of labor greater than 20 hours O.R. = 2.7 (1.3 to 5.7), and birthweight over 4,000 grams O.R. = 2.1 (0. 9 to 4.8) were associated with dystocia. CONCLUSION:Epidural analgesia appears to be a marker of abnormal labor rather than a cause of dystocia. High concentration anesthetics and epinephrine should be avoided, as they may influence labor. Randomized, controlled trials of this technique will be difficult to do; our work should reassure patients and their clinicians that epidural analgesia does not adversely affect labor.
journal_name
J Clin Anesthjournal_title
Journal of clinical anesthesiaauthors
Thompson TT,Thorp JM Jr,Mayer D,Kuller JA,Bowes WA Jrdoi
10.1016/s0952-8180(97)00222-5subject
Has Abstractpub_date
1998-02-01 00:00:00pages
58-65issue
1eissn
0952-8180issn
1873-4529pii
S0952818097002225journal_volume
10pub_type
临床试验,杂志文章abstract：STUDY OBJECTIVE:To examine the risk of perioperative stroke on in-hospital morbidity and mortality in staged coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) procedures. DESIGN:The National Inpatient Sample (NIS) database was used to extract data on all patients who underwent staged CABG CEA pro...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2017.03.024
更新日期：2017-06-01 00:00:00
abstract：:A case of unusual triple knotting of a central venous catheter inserted through the left basilic vein is reported. The catheter with intact triple knots could be withdrawn without an invasive maneuver. A possible cause of triple knotting was discussed in regard to the anatomic configuration of the central veins. This ...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/0952-8180(89)90045-7
更新日期：1989-01-01 00:00:00
abstract：STUDY OBJECTIVE:To evaluate the reliability of assessments of nasal flow rate for improved nostril selection for nasotracheal intubation. DESIGN:Prospective, randomized, double-blinded study. SETTING:Operating room of a university-affiliated hospital. PATIENTS:118 ASA physical status 1 and 2 patients, aged 18-65 yea...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jclinane.2011.08.006
更新日期：2012-06-01 00:00:00
abstract：STUDY OBJECTIVE:To examine perioperative management and complications in patients undergoing pneumonectomy. DESIGN:Observational cohort study. SETTING:University-affiliated city hospital. MEASUREMENTS:65 patients who underwent unilateral pneumonectomy for resection of lung cancer between March 1997 and October 2007 ...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2009.02.013
更新日期：2010-02-01 00:00:00
abstract：STUDY OBJECTIVE:The objective was to present a proof of concept for a simple and consistently successful ultrasonograpy (US)-guided technique to block the internal branch of the superior laryngeal nerve (iSLN). DESIGN:This was a volunteer and cadaver anatomy study. SETTING:The setting was an anesthesiology department...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2015.07.016
更新日期：2015-11-01 00:00:00
abstract：:This report highlights transient Horner's syndrome and trigeminal nerve palsy following labor epidural analgesia. A 29-year-old primigravida had a lumbar epidural catheter placed for analgesia in labor. The analgesia was maintained by infusion of a dilute local anesthetic/opioid mixture and turned off after achieving ...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/s0952-8180(02)00406-3
更新日期：2002-11-01 00:00:00
abstract：BACKGROUND:Intraoperative remifentanil has been associated with postoperative hyperalgesia, higher visual analogic pain scores, and increased postoperative morphine consumption. However, this has not been investigated from patient's perspective by using a patient-reported outcomes (PROs) approach with a validated quest...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jclinane.2015.12.025
更新日期：2016-06-01 00:00:00
abstract：:We present a case in which an anemic patient with religious objections to blood transfusion experienced three episodes of severe myocardial ischemia during the perioperative period. The first episode of ischemia was successfully treated by discontinuing isoflurane and resolving the hypotension. The second and third ep...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/0952-8180(96)00086-4
更新日期：1996-08-01 00:00:00
abstract：STUDY OBJECTIVE:To establish a useful ultrasonic approach to the epidural space so as to optimize pre-puncture diagnostics. DESIGN:Prospective study. SETTING:University clinic. PATIENTS:60 participants (19 to 34 years of age), 40 healthy volunteers (20 male, 20 female) and 20 parturients. INTERVENTIONS:Ultrasound s...
journal_title：Journal of clinical anesthesia
pub_type： 临床试验,杂志文章
doi：10.1016/s0952-8180(01)00245-8
更新日期：2001-05-01 00:00:00
abstract：STUDY OBJECTIVE:To evaluate the onset time, success rate, and recovery profile of unilateral spinal anesthesia produced with 4 mg, 6 mg, and 8 mg of 0.5% hyperbaric bupivacaine. DESIGN:Prospective, randomized, blinded study. SETTING:Outpatient anesthesia unit at a University Hospital. PATIENTS:90 ASA physical status...
journal_title：Journal of clinical anesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/s0952-8180(03)00078-3
更新日期：2003-08-01 00:00:00
abstract：STUDY OBJECTIVE:To compare the effects of Truview PCD™ video laryngoscopy (TVL) and Macintosh blade direct laryngoscopy (MDL) on hemodynamic responses observed during laryngoscopy and orotracheal intubation conditions in geriatric patients. DESIGN:Randomized prospective study. SETTING:Operating room. PATIENTS:One hu...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2016.09.010
更新日期：2016-12-01 00:00:00
abstract：:The use of direct oral anticoagulants including apixaban, rivaroxaban, and dabigatran, which are approved for several therapeutic indications, can simplify perioperative and postoperative management of anticoagulation. Utilization of regional neuraxial anesthesia in patients receiving anticoagulants carries a relative...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章,评审
doi：10.1016/j.jclinane.2016.02.028
更新日期：2016-08-01 00:00:00
abstract：:A 48-year-old man with end-stage liver disease and aortic stenosis (AS), was being evaluated for liver transplantation. This report focuses on the question of which medical problem to correct first, the end-stage liver disease or the AS. Risk factors for surgical correction of AS and liver transplantation are reviewed...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章,评审
doi：10.1016/s0952-8180(98)00018-x
更新日期：1998-05-01 00:00:00
abstract：:Placement of a central venous catheter into an internal thoracic vein occurs in approximately 2% of all catheterizations. A case in which a pulmonary artery catheter was trapped within the internal thoracic vein during orthotopic heart transplantation is presented. ...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2010.03.010
更新日期：2011-05-01 00:00:00
abstract：STUDY OBJECTIVE:To investigate whether a novel ultrasound device may be used with a simplified augmented reality technique, and to compare this device with conventional techniques during vascular access using a vascular phantom. DESIGN:Prospective, randomized study. SETTING:Anesthesiology and Pain Medicine department...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jclinane.2014.02.010
更新日期：2014-09-01 00:00:00
abstract：:The acceptance of new and increasingly expensive technologies is a major component of the rising costs of health care. While the practice of anesthesia has been relatively immune from the effects of cost containment, it is inevitable that practitioners will have to justify costly practices. Available pharmacoeconomic ...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/s0952-8180(05)80008-x
更新日期：1994-09-01 00:00:00
abstract：BACKGROUND:Cardiac arrest is associated with very high mortality and causes neurological dysfunction in the survivors. Therapeutic hypothermia is one of the recommended modality in the postarrest management. However, recent findings question its benefit in postarrest management. This meta-analysis has been conceptualiz...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章,meta分析,评审
doi：10.1016/j.jclinane.2016.03.001
更新日期：2016-09-01 00:00:00
abstract：STUDY OBJECTIVE:To compare the efficacy of patient-controlled analgesia (PCA) to physician-controlled analgesia in patients undergoing extracorporeal shock wave lithotripsy (ESWL). DESIGN:Prospective, randomized trial. SETTING:New Jersey Kidney Stone Treatment Center at Robert Wood Johnson University Hospital, New Br...
journal_title：Journal of clinical anesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/0952-8180(95)00008-6
更新日期：1995-05-01 00:00:00
abstract：:Administration of vecuronium by infusion is an increasingly common technique, both in the operating room and in the intensive care unit (ICU), for patients requiring prolonged neuromuscular blockade and mechanical ventilation. The major advantage of vecuronium over older neuromuscular blocking agents is its rapid excr...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/0952-8180(90)90107-e
更新日期：1990-07-01 00:00:00
abstract：:A 13-year-old girl with Goltz's (Goltz-Gorlin) syndrome (focal dermal hypoplasia) and cloacal exstrophy underwent day surgery cystoscopy. During the administration of inhalation anesthesia by mask, persistent partial upper airway obstruction was noted. Direct laryngoscopy unexpectedly showed variously sized verrucous ...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/0952-8180(91)90190-x
更新日期：1991-09-01 00:00:00
abstract：:The need for greater efficiency in OR management will become apparent as hospitals are forced to respond to a myriad of pressures imposed by the external environment. The most effective strategy in dealing with this challenge will be realized by adopting a "systems" approach to OR functions as opposed to the more trad...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/0952-8180(95)00159-x
更新日期：1995-11-01 00:00:00
abstract：:Insertion of drug-eluting stents is one of the strategies for treating patients with coronary artery disease. These patients can be a perioperative challenge in management as they need to be maintained on antiplatelet therapy to prevent stent thrombosis, which puts them at an increased risk for surgical bleeding. Rece...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2008.11.013
更新日期：2009-11-01 00:00:00
abstract：:The neurologic implications of diabetic hyperglycemia depend on whether the ischemic insult is permanent or temporary. Laboratory studies show that following permanent focal ischemia, a situation analogous to stroke, diabetic hyperglycemia is protective in the penumbral region, whereas it may slightly increase infarct...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章,评审
doi：10.1016/s0952-8180(97)00021-4
更新日期：1997-06-01 00:00:00
abstract：STUDY OBJECTIVE:Preoperative anxiety is commonly reported by people undergoing surgery. A significant number of studies have found a correlation between preoperative anxiety and post-operative morbidity. Various methods of complementary and alternative medicine (CAM) were found to be effective in alleviating preoperati...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jclinane.2015.10.017
更新日期：2016-03-01 00:00:00
abstract：:The American Society of Anesthesiologists, the Anesthesia Patient Safety Foundation, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), and the Patient Safety and Quality Improvement Act of 2005 encourage anesthesiology departments to institute systematic improvements in patient safety, inc...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2008.09.010
更新日期：2009-08-01 00:00:00
abstract：:We report a case of recurrent ST-segment elevations totaling 7 times over 3 hours during subtotal gastrectomy and the early postoperative period in a patient with no history of coronary artery disease. Possible contributing factors include cold stimulus, epidural anesthesia, and inadequate depth of anesthesia. The fir...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2004.08.013
更新日期：2005-08-01 00:00:00
abstract：:We describe a case of orthotopic liver transplantation used as a therapeutic method to correct high output cardiac failure related to a liver arteriovenous fistula due to hereditary hemorrhagic telangiectasia. Detailed hemodynamic changes as they occurred during liver transplantation are described. ...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/s0952-8180(00)00160-4
更新日期：2000-06-01 00:00:00
abstract：BACKGROUND:Postoperative nausea and vomiting (PONV) is one of the common complications in patients who have undergone surgery with general anesthesia. The association of intraoperative use of remifentanil with PONV has remained controversial. The aim of the current study was to determine the association of dose of intr...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2016.04.018
更新日期：2016-11-01 00:00:00
abstract：STUDY OBJECTIVE:To evaluate and compare cardiovascular responses to a new method of orotracheal intubation incorporating TV monitoring, with conventional orotracheal intubation via rigid blade laryngoscopy. DESIGN:Prospective single-blind study. SETTING:Operating room of a medical college hospital. PATIENTS:90 ASA p...
journal_title：Journal of clinical anesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/s0952-8180(00)00196-3
更新日期：2000-11-01 00:00:00
abstract：PURPOSE:Anesthesiologists are often involved in the early management and resuscitation of patients who have sustained cervical spine injuries (CSIs). The most crucial step in managing a patient with suspected CSI is the prevention of further insult to the cervical spine (C-spine). In this review, important factors rela...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章,评审
doi：10.1016/j.jclinane.2005.04.003
更新日期：2005-12-01 00:00:00
