OB Div News March 2009
|
|
- Suzanna Booth
- 5 years ago
- Views:
Transcription
1 OB Div News March 2009 Several articles in this month s review have come from Canadian institutions. In spite of my pride in being Canadian, which was enhanced during the Olympics, this is purely coincidental. The ones chosen for review are ones which I think are of value to the practicing OB anesthesiologist. Preventing Hypotension As readers of the OB Div News are aware there has been considerable attention by researchers to preventing spinalinduced hypotension. While more recent studies have focused on the use of vasopressors, such as ephedrine and phenylephrine, others have looked at the effects of hydration. While studies have suggested that a preload of colloid has a degree of effectiveness, a preload of crystalloid has not been found to be of any benefit. The concept of coload, administration of intravenous fluid concomitantly with the onset of the spinal block, has been suggested as an alternate technique. Banerjee et al (Can J Anesth 2010;57:24-31) sought RCTS comparing coload and preload prior to cesarean delivery. The researchers found six manuscripts, one of which was eliminated; they also found 3 references in abstract form. There were a total of 518 subjects. The median quality score was 3 (out of 5). The definition of hypotension varied among the studies (5 used a 20% reduction of systolic BP from baseline, either a 20% reduction or a SBP <100 torr in another study and a decrease in SBP of 10% in two studies). The incidence of hypotension in the coload group was 59.3% compared to 62.4% in the preload group. This led the authors to conclude that timing of fluid loading was not an important determinant of hypotension and this applied to colloid or crystalloid.
2 George et al (Anesth Analg 2010;110:154-8) have done an updown determination of the 90% effective dose of phenylephrine for the treatment of spinal-induced hypotension. They consented 66 subjects but 1 withdrew as she received atropine prior to spinal anesthesia due to a vasovagal reaction. The investigators performed a standard up-down study beginning with a dose of 100 μg of phenylephrine to treat a decrease in SBP of 20% from baseline. The incremental increase or decrease in phenylephrine was 20 μg. Failure of treatment was persistence of hypotension 1 min after administration of the vasopressor. If that occurred, the attending anesthesiologist could use whatever vasopressor they wanted. Results: 69% developed hypotension and so were treated with phenylephrine. The mean time from IT injection to hypotension was 5.8 +/-3.6 min. The ED 90 for phenylephrine was 147 μg. This dose was 50% higher than their anticipated results. At the time of their study their normal treatment dose was 100 μg. They suggest that use of 150 μg might be more efficacious. Tuffier s Line Pysyk et al (Can J Anesth 2010;57:46-9) have once again looked at the relationship between the intercristal (Tuffier s line) and level as determined by ultrasound in a group of volunteers. These investigators 114 adult subjects who were hospital staff or patients who were seen in the pre-admission unit at Ottawa Civic Hospital. The subjects were position in the sitting position as if undergoing a neuraxial block. The iliac crest was then identified and marked. An ultrasound was then used to 2
3 determine the level. The palpated Tuffier s line was at the L3-4 interspace in 73% of subjects. When the level was palpated at the L2-3 interspace the subject was more likely to be male and to be taller. Although the majority of subjects were found to have the intercristal line at the L3-4 interspace it is important to remember that in several subjects it was higher. As well, no pregnant subjects were included in this study and pregnancy with its physiological changes may lead to a false identification of the L3-4 interspace. Although this may not be significant in the majority of patients it can be important if one is doing a spinal anesthetic at the L2-3 interspace using the intercristal line to determine one s level. In that circumstance one could be one or two levels higher which would increase the chance that the spinal cord may be present at the site of needle insertion. One might want to review the following articles on this subject: Reynolds F. Damage to the conus medullaris following spinal anaesthesia. Anaesthesia 2001;56:238-47; Broadbent CR, et al. Ability of anaesthetists to identify a marked lumbar interspace. Anaesthesia 2000;55: and the others listed in the references of this study. Is Epidural Morphine Indicated after Vaginal Delivery? Epidural morphine has become a standard for postoperative analgesia after cesarean delivery under epidural anesthesia. Some anesthesiologists have also administered epidural morphine following forceps delivery. Now, Macarthur et al (Anesth Analg 2010;110:159-64) have published their doubleblind, randomized, placebo-controlled trial of its use following vaginal delivery. The background to this study was a previous 3
4 study (Macarthur A, Macarthur C. Am J Obstet Gynecol 2004;191: ) done at their institution they found that women reported difficulty with sitting, urinating because of postpartum pain, even if they had minimal perineal trauma. The investigators approached 1110 women with labor epidural analgesia and randomized 231 (those who did not participate declined, or had cesarean delivery or rapid delivery or allergy to analgesics). Three withdrew after randomization leaving 228 in the study. Of these 113 received epidural morphine and 115 placebo. Of those who delivered vaginally, 1/3 had an operative vaginal delivery and 74% had major perineal trauma. The dose of EM used was 2.5 mg diluted in 10 ml of saline; the placebo was saline. Standard EM orders were used in the 24 h postpartum. All subjects received scheduled acetaminophen and ibuprofen. They could also receive oral codeine or IM morphine as required. The primary outcome was the proportion of women who received opioid analgesia in the 1 st 24 h postpartum. There were several secondary outcomes including side effects of the epidural morphine. In addition to standard demographics they also collected information as to type of vaginal delivery, degree of perineal trauma as recorded in the delivery record, neonatal weight, etc. There was a 78% reduction in the need for postpartum opioid analgesics (p<0.001) in the EM group and this was consistent for nullips as well as multips, and for differing degrees of perineal trauma. Of interest, there was no statistical difference in the incidence of side effects between groups, although the incidence in the EM group was double that in placebo. The most common side effect was urinary retention (10% placebo vs 4
5 18% EM). As the incidence of side effects was not the primary outcome many more subjects would have been needed to prove statistical difference. In the discussion the authors suggest that their study may have underestimated the benefits of EM as the protocol included regular acetaminophen and NSAIDs. In situations where these are provided on a prn basis there might be a greater effect of EM. The downside of EM is that it requires greater monitoring in the immediate postpartum period. To complete a look at treatment of pain after vaginal delivery one should consider the possibility of chronic pain if it is inadequately treated. Kainu et al (Int J Obstet Anesth 2010;19-4-9) used a questionnaire to evaluate persistent pain after caesarean section and vaginal birth. In that study they found that chronic pain was more common one year postpartum after cesarean delivery compared to vaginal delivery (18% v 10%). Of those with chronic pain 55% of women who delivered vaginally had mild pain while 40% had moderate to unbearable pain (5% did not respond). They found that chronic pain was associated with a history of previous pain, chronic disease and pain after delivery. So this would imply that we should treat acute postpartum pain not only in our cesarean delivery patients but also those who deliver vaginally. This latter article is accompanied by an editorial by Lavand homme (IJOA 2010;19:1-2) and is worthwhile reading. Enjoy! SOGC Clinical Practice Guideline A Clinical Practice Guideline titled Obesity in Pregnancy has been published (JOGC 2010;32:165-73). Recommendation #8 5
6 states Antental consultation with an anesthesiologist should be considered to review analgesic options and to ensure a plan is in place should a regional anesthetic be chosen. In their discussion on this point they state consideration should be given to early epidural in labor. My perspective is that anesthetic consultation should be mandatory for a morbidly obese parturient and an early epidural should be encouraged. Does fentanyl in the epidural affect breastfeeding? Wilson et al (Anaesthesia 2010;65:145-53) have done a secondary analysis on data accumulated from the COMET trial to see whether epidural fentanyl affects early breastfeeding. For details of the COMET trial see Wilson MJ et al (Anesthesiology 2001;97: ). The authors of this retrospective look found that epidural analgesia with or without fentanyl did not affect initiation of breast feeding. Undoubtedly there will be many more studies looking at the effect of analgesia on breastfeeding. Instead of studies, I would suggest that efforts should be made to ensure that there is adequate lactation consultant support. Other Interesting Articles Green LK, Paech MJ. Obstetric epidural catheter-related infections at a major teaching hospital: a retrospective case series. IJOA 2010;19: Joanne Douglas, MD Vancouver B.C. 6
What s New in Post-Cesarean Analgesia?
Anesthesia & Obstetrics What s New in Post-Cesarean Analgesia? October 23rd, 2013 2013 UCSF What Does The Evidence Tell Us? Mark Rollins, MD, PhD UC SF Post-Delivery Pain (Mean pain scores for first 24
More informationCesarean Section Should be Managed: Low Dose / CSE versus High Dose Spinals with Vasopressors
Cesarean Section Should be Managed: Low Dose / CSE versus High Dose Spinals with Vasopressors Cristian Arzola MD MSc Department of Anesthesia and Pain Management Mount Sinai Hospital and University of
More informationCardiovascular Effects of Anesthesia for Cesarean Delivery in the Cardiac Patient
Cardiovascular Effects of Anesthesia for Cesarean Delivery in the Cardiac Patient Katherine W. Arendt, M.D. Associate Professor of Anesthesiology Mayo Clinic, Rochester, Minnesota Cardiac Problems in Pregnancy
More informationCSE Analgesia Represents the Gold Standard for Regional Analgesia in Labour
CSE Analgesia Represents the Gold Standard for Regional Analgesia in Labour Dr Jason Reidy Nuffield Department of Anaesthetics Oxford University Hospitals CSE analgesia does not represent the gold standard
More informationRichard Smiley, MD, PhD Virginia Apgar MD Professor of Anesthesiology Chief, Obstetric Anesthesia Columbia University Medical Center New York, NY,
Richard Smiley, MD, PhD Virginia Apgar MD Professor of Anesthesiology Chief, Obstetric Anesthesia Columbia University Medical Center New York, NY, USA Disclosures Off label use: Fentanyl, Sufentanil IT
More informationSri Lankan Journal of Anaesthesiology 17(2) : (2009)
Sri Lankan Journal of Anaesthesiology 17(2) : 55-60 (2009) COMPARISON OF PROPHYLACTIC INTRAMUSCULAR EPHEDRINE WITH PRELOADING VERSUS PRELOADING ALONE IN PREVENTION OF HYPOTENSION DURING ELECTIVE CAESAREAN
More informationRegional Anaesthesia for Caesarean Section
Regional Anaesthesia for Caesarean Section "The Best Recipe" Warwick D. Ngan Kee Dept of Anaesthesia & Intensive Care The Chinese University of Hong Kong What I will not do. Magic recipes One shoe to fit
More informationCombined spinal-epidural analgesia represents the gold standard for regional analgesia in labour
Combined spinal-epidural analgesia represents the gold standard for regional analgesia in labour Felicity Plaat Queen Charlotte s Hospital, Imperial College NHS Trust London Combined spinal-epidural analgesia
More informationCurrent Management of Labour Analgesia Epidural or CSE, Bolus or Infusions?
Current Management of Labour Analgesia Epidural or CSE, Bolus or Infusions? Dr Mark Esler Queen Charlotte s and Chelsea Hospital Imperial College Healthcare NHS Trust 2 nd October 2013 2 kangaroos and
More informationOBSTETRICS Intrathecal morphine reduces breakthrough pain during labour epidural analgesia
British Journal of Anaesthesia 98 (2): 241 5 (2007) doi:10.1093/bja/ael346 Advance Access publication January 8, 2007 OBSTETRICS Intrathecal morphine reduces breakthrough pain during labour epidural analgesia
More informationIn a previous study from our institution, we found
A Randomized, Double-Blind, Placebo-Controlled Trial of Morphine Analgesia After Vaginal Delivery Alison Macarthur, MD, MSc* Charles Imarengiaye, MD Luminita Tureanu, MD Kristi Downey, MSc* BACKGROUND:
More informationSafety and quality of neuraxial analgesia. Ulla Sipiläinen HUCS Jorvi hospital
Safety and quality of neuraxial analgesia Ulla Sipiläinen 6.10. 2011 HUCS Jorvi hospital Chestnut s Checklist Preparation for neuraxial labor analgesia 1.Communicate (early) with obst provider review parturient
More informationREGIONAL/LOCAL ANESTHESIA and OBESITY
REGIONAL/LOCAL ANESTHESIA and OBESITY Jay B. Brodsky, MD Stanford University School of Medicine Jbrodsky@stanford.edu Potential Advantages Regional compared to General Anesthesia Minimal intra-operative
More informationClosed-loop Double-pump Automated System Manual Boluses
Closed-loop Double-pump Automated System versus Manual Boluses to treat Hypotension during Spinal Anaesthesia for Caesarean Section: randomised controlled trial Dr. Ban Leong SNG MBBS, MMED, FANZCA, FFPMANZCA,
More informationPost-operative Analgesia for Caesarean Section
Post-operative Analgesia for Caesarean Section Introduction Good quality analgesia after any surgery leads to earlier mobilisation, fewer pulmonary and cardiac complications, a reduced risk of DVT and
More informationChronic pain after childbirth. Petter Kainu Split
Chronic pain after childbirth Petter Kainu Split 9.5.13 Backround: 128 milj. births per year world wide 18.5 milj. caesarean sections (WHO 2008) 234 milj. surgical operations per year (WHO 2004) Chronic
More informationORIGINAL ARTICLE A COMPARATIVE STUDY BETWEEN 0.5% HYPERBARIC BUPIVACAINE AND 0.5% HYPERBARIC BUPIVACAINE WITH
A COMPARATIVE STUDY BETWEEN 0.5% HYPERBARIC BUPIVACAINE AND 0.5% HYPERBARIC BUPIVACAINE WITH 25 mcg FENTANYL IN SPINAL ANAESTHESIA IN OBSTETRIC PATIENTS UNDERGOING ELECTIVE LSCS A. V. Abhinav 1, Harshavardhan
More informationWhat s new in obstetric anesthesia?
SAOA 2013 - SPRING MEETING BERN What s new in obstetric anesthesia? PD Dr. Med Georges Savoldelli Médecin Adjoint Unité d anesthésiologie gynéco-obstétricale Service d Anesthésiologie, HUG An objectively
More informationPost Caesarean Analgesia An Update. Kim Ekelund MD, PhD, associate professor Rigshospitalet Copenhagen, Denmark
Post Caesarean Analgesia An Update Kim Ekelund MD, PhD, associate professor Rigshospitalet Copenhagen, Denmark Post caesarean analgesia No Conflicts of Interests Neuraxial opioids Multimodal therapy Plan
More informationEffects of IV Ondansetron during spinal anaesthesia with Ropivacaine and Fentanyl
Original article Effects of IV Ondansetron during spinal anaesthesia with Ropivacaine and Fentanyl 1Dr Bipul Deka, 2 Dr Bharat Talukdar, 3 Dr. Amal Kumar Laha, 4 Dr. Rupak Bhattacharjee 1Assistant Professor,
More informationCase Discussions Cynthia A. Wong, M.D.
Case Discussions Cynthia A. Wong, M.D. Association des Anesthѐsiologistes du Quѐbec April 2014 CASE 1 Maternal Mortality Lewis G (ed). CEMACH 2007. Saving Mothers Lives 2003-2005 Pregnancy Complications
More informationInduction position for spinal anaesthesia: Sitting versus lateral position
11 ORIGINAL ARTICLE Induction position for spinal anaesthesia: Sitting versus lateral position Khurrum Shahzad, Gauhar Afshan Abstract Objective: To compare the effect of induction position on block characteristics
More informationInitiating Labour Analgesia in 2020: Predicting the Future Epidurals, CSEs, Spinal Catheters, Epidrum & Epiphany
Initiating Labour Analgesia in 2020: Predicting the Future Epidurals, CSEs, Spinal Catheters, Epidrum & Epiphany Kenneth E Nelson, M.D. Associate Professor Wake Forest University, North Carolina, USA Initiating
More informationPain relief after cesarean section: Oral methadone vs. intramuscular pethidine
Original Article Pain relief after cesarean section: Oral methadone vs. intramuscular pethidine Azar Danesh Shahraki, 1 Mitra Jabalameli, 2 Somayeh Ghaedi 3 1 Associate Professor, Department of Obstetrics
More informationPre-eclampsia: key issues. Robin Russell Nuffield Department of Anaesthetics John Radcliffe Hospital Oxford
Robin Russell Nuffield Department of Anaesthetics John Radcliffe Hospital Oxford Antenatal Issues Labour Analgesia Anaesthesia for Delivery High Dependency Care Hypertension systolic >140 mmhg or diastolic
More informationEpidural Analgesia: The Best Mix
Epidural Analgesia: The Best Mix Clinical Associate Professor Nolan McDonnell FANZCA MClinRes Department of Anaesthesia and Pain Medicine King Edward Memorial Hospital for Women Subiaco, Western Australia
More informationPerioperative Pain Management
Perioperative Pain Management Overview and Update As defined by the Anesthesiologist's Task Force on Acute Pain Management are from the practice guidelines from the American Society of Anesthesiologists
More informationLabor Epidural: Local Anesthetics and Beyond
Goals: Labor Epidural: Local Anesthetics and Beyond Pedram Aleshi MD The Changing Practice of Anesthesia September 2012 Review Concept of MLAC Local anesthetic efficacy Local anesthetic sparing effects:
More informationCombined spinalepidural. epidural analgesia in labour (review) By Neda Taghizadeh
Combined spinalepidural versus epidural analgesia in labour (review) By Neda Taghizadeh Cochrane review Cochrane collaboration was founded in 1993 and is named after Archie Cochrane (1909-1988), British
More informationObstetrical Anesthesia. Safe Pain Relief for Childbirth
Obstetrical Anesthesia Safe Pain Relief for Childbirth Introduction Pain relief (analgesia) for labor and delivery is now safer than ever. In the United States approximately two-thirds of all women receive
More informationAnalgesia after c delivery - wound infusions, tap blocks and intrathecal opioids; what more can we offer our patients?
Analgesia after c delivery - wound infusions, tap blocks and intrathecal opioids; what more can we offer our patients? Ashraf S Habib, MBBCh, MSc, MHSc, FRCA Associate Professor of Anesthesiology Interim
More informationOriginal Article. Moinul Hossain 1*, Abu Hasanat Md. Ahsan Habib 2, Md. Mustafa Kamal 3, Md. Mizanur Rahman 4
Original Article Comparative study between lumbar epidural and spinal anaesthesia in elective caesarean section: comparison of maternal status during operation and in the post operative period Moinul Hossain
More informationOAA Survey 156: Current prescribing practices for post-operative analgesia following emergency and elective LSCS
OAA Survey 56: Current prescribing practices for post-operative analgesia following emergency and elective LSCS Janis M Ferns, Jennifer Lambert, Dharshini Radhakrishnan 2. Specialty Trainee, Barts and
More informationRemifentanil PCA In Labor
Remifentanil PCA In { Jennifer Lucero, MD Clinical Instructor UCSF Department of Anesthesia Remifentanil PCA in Discuss the Pharmokinectics of Remifentanil Review literature on the use of Remifentanil
More informationCAESAREAN SECTION Brian Fredman
CHAPTER 3 GYNAECOLOGICAL SURGERY CAESAREAN SECTION Brian Fredman Review of evidence: surgical site infusion Of the seven studies on surgical site local anaesthetic infusion after Caesarean section performed
More informationPain Relief Options for Labor. Providing you with quality care, information and support
Pain Relief Options for Labor Providing you with quality care, information and support What can I expect during my labor and delivery? As a patient in the Labor and Delivery suite at Lucile Packard Children
More informationTitle: Epidural Analgesia for Pain Management in Labour. Date: May 03, 2007
Title: Epidural Analgesia for Pain Management in Labour Date: May 03, 2007 Context and policy issues: Balancing pain control with unwanted maternal and neonatal effects remains a hotly debated topic for
More informationRegional Anaesthesia for Caesarean Section Warwick D. Ngan Kee
Regional Anaesthesia for Caesarean Section Warwick D. Ngan Kee Chair, Department of Anesthesiology Sidra Medicine Doha, Qatar D I S C L O S U R E S No financial disclosures No industry affiliations No
More informationAddition of Adrenaline to Chloroprocaine Provides a Moderate Duration Time for Epidural Anaesthesia in Elective Caesarean Section
The Journal of International Medical Research 2012; 40: 1099 1107 Addition of Adrenaline to Chloroprocaine Provides a Moderate Duration Time for Epidural Anaesthesia in Elective Caesarean Section SW FENG,
More informationDURAL PUNCTURE EPIDURAL ANALGESIA IS NOT SUPERIOR TO CONTINUOUS LABOR EPIDURAL ANALGESIA
DURAL PUNCTURE EPIDURAL ANALGESIA IS NOT SUPERIOR TO CONTINUOUS LABOR EPIDURAL ANALGESIA Deepak Gupta *, Arvind Srirajakalidindi *, Vitaly Soskin ** Abstract Background: Some anesthesiologists consider
More informationPOLICY and PROCEDURE
Misericordia Community Hospital Administration of Intravenous FentaNYL During Labour POLICY and PROCEDURE Labour and Delivery Manual Original Date Revised Date Approved by: Director, Women s Health, Covenant
More informationCHA Gumi Medical Center, CHA University, Gumi, Korea
Anesth Pain Med 2014; 9: 65-69 Clinical Research Comparison of 0.5% ropivacaine with fentanyl and 0.75% ropivacaine used in extension of a preexisting labor epidural for emergency cesarean section: retrospective
More informationBeneficial effects of the addition of intrathecal fentanyl to bupivacaine for spinal anesthesia in cesarean section
Anesth Pain Med 2017; 12: 233-239 https://doi.org/10.17085/apm.2017.12.3.233 Clinical Research http://crossmark.crossref.org/dialog/?doi=10.17085/apm.2017.12.3.233&domain=pdf&date_stamp=2017-07-25 pissn
More informationPreoperative dextrose does not affect spinalinduced. elective Cesarean section 1024 REPORTS OF INVESTIGATION
1024 REPORTS OF INVESTIGATION Preoperative dextrose does not affect spinalinduced hypotension in elective Cesarean section Deborah Wilson MBBS, Joanne Douglas lvto, Robert Heid MD, Dan Rurak DPHIL ~L~O~:
More informationInfluence of the timing of administration of crystalloid on maternal hypotension during spinal anesthesia for cesarean delivery: preload versus coload
Oh et al. BMC Anesthesiology 2014, 14:36 RESEARCH ARTICLE Open Access Influence of the timing of administration of crystalloid on maternal hypotension during spinal anesthesia for cesarean delivery: preload
More informationEfficacy Of Ropivacaine - Fentanyl In Comparison To Bupivacaine - Fentanyl In Epidural Anaesthesia
ISPUB.COM The Internet Journal of Anesthesiology Volume 33 Number 1 Efficacy Of Ropivacaine - Fentanyl In Comparison To Bupivacaine - Fentanyl In Epidural Anaesthesia S Gautam, S Singh, R Verma, S Kumar,
More informationNerve Blocks & Long Acting Analgesia for Plastic Surgeons. Karol A Gutowski, MD, FACS
Nerve Blocks & Long Acting Analgesia for Plastic Surgeons Karol A Gutowski, MD, FACS Disclosures None related to this topic Why is Non-Opioid Analgesia Important Opioid epidemic Less opioid use Less PONV
More informationANESTHESIA FOR CHILDBIRTH
Southwest Ob / Gyn Associates, L.L.P 16651 Southwest Freeway, Suite 200 Sugar Land, TX 77479 7737 Southwest Freeway, Suite 895 Houston, TX 77074 Telephone: (713) 774-5131 Fax: (713) 774-4336 ANESTHESIA
More informationCOPYRIGHTED MATERIAL. Consent for obstetric analgesia and anesthesia CHAPTER 1. M. Joanne Douglas. Background. Methods: literature search.
CHAPTER 1 Consent for obstetric analgesia and anesthesia M. Joanne Douglas Background Informed consent is based on the ethical principle of autonomy and has several components. The requirements for informed
More informationGuideline for the Post Operative Management of Women who have received Intrathecal or Epidural Opioid Analgesia for Caesarean Section
Guideline for the Post Operative Management of Women who have received Intrathecal or Epidural Opioid Analgesia for Caesarean Section Speciality: Maternity Approval Body: Labour Ward Forum Approval Date:
More informationComplications of Neuraxial Anesthesia An Ounce of Prevention is Worth a Pound of Cure
Complications of Neuraxial Anesthesia An Ounce of Prevention is Worth a Pound of Cure Brian J Kasson CRNA MHS Faculty/Clinical Instructor Nurse Anesthesia Program Northern Kentucky University Staff Nurse
More informationSwiss Association of Obstetric Anesthesia Swiss Association of Anesthesia & Resuscitation Satellite Meeting Interlaken, Switzerland 2007 Lawrence C.
CSE s for Labor Analgesia PRO! Swiss Association of Obstetric Anesthesia Swiss Association of Anesthesia & Resuscitation Satellite Meeting Interlaken, Switzerland 2007 Lawrence C. Tsen, MD Director of
More informationSpinal Anaesthesia for Caesarean Delivery. Pervez Sultan University College London Hospital
Spinal Anaesthesia for Caesarean Delivery Pervez Sultan University College London Hospital Disclosures How to Deliver an Evidence- Based Spinal Anaesthetic CSE vs. spinal Block height assessment Drugs
More informationED 50 of Hyperbaric Bupivacaine With Fentanyl for Cesarean Delivery Under Combined Spinal Epidural in Normotensive and Preeclamptic Patients
ORIGINAL ARTICLE ED 50 of Hyperbaric Bupivacaine With Fentanyl for Cesarean Delivery Under Combined Spinal Epidural in Normotensive and Preeclamptic Patients Asha Tyagi, MD, DNB, Aanchal Kakkar, MD, Surendra
More informationEpidural Analgesia in Labor - Whats s New
Epidural Analgesia in Labor - Whats s New Wichelewski Josef 821 Selective neural blockade has many clinical applications in medicine but nowhere has its use been so well accepted than in the field of Obstetrics.
More informationComparison of fentanyl versus fentanyl plus magnesium as post-operative epidural analgesia in orthopedic hip surgeries
Original Research Article Comparison of fentanyl versus fentanyl plus magnesium as post-operative epidural analgesia in orthopedic hip surgeries P V Praveen Kumar 1*, Sreemanth 2 1 Associate Professor,
More informationThe Harvard community has made this article openly available. Please share how this access benefits you. Your story matters. doi:10.
Comparison of Spinal Block Levels between Laboring and Nonlaboring Parturients Using Combined Spinal Epidural Technique with Intrathecal Plain Bupivacaine The Harvard community has made this article openly
More informationHead Elevation in Spinal-Epidural Anesthesia Provides Improved Hemodynamics and Appropriate Sensory Block Height at Caesarean Section
Original Article http://dx.doi.org/10.3349/ymj.2015.56.4.1122 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 56(4):1122-1127, 2015 Head Elevation in Spinal-Epidural Anesthesia Provides Improved Hemodynamics
More informationMD (Anaesthesiology) Title (Plan of Thesis) (Session )
S.No. 1. To study the occurrence of postoperative hyponatremia in paediatric patients under 2 years of age 2. Influence of timing of intravenous fluid therapy on maternal hemodynamics in patients undergoing
More informationShow Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital
Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital Overview Review overall (ERAS and non-eras) data for EA, PVB, TAP Examine
More informationEnhanced Recovery After Cesarean Section. Kimberly Babiash, MD, MBA Charese Dakhil, MD Mid-Continent Anesthesiology Chartered
Enhanced Recovery After Cesarean Section Kimberly Babiash, MD, MBA Charese Dakhil, MD Mid-Continent Anesthesiology Chartered Objectives 1. Provide background information on enhanced recovery (also known
More informationSonia Ouerghi *, Mohamed A. Bougacha **,
Combined use of crystalloid preload and low dose spinal anesthesia for preventing hypotension in spinal anesthesia for cesarean delivery: * l a randomized controlled trial Sonia Ouerghi *, Mohamed A. Bougacha
More informationISSN X (Print) Research Article
Scholars Journal of Applied Medical Sciences (SJAMS) Sch. J. App. Med. Sci., 2014; 2(4B):1255-1259 Scholars Academic and Scientific Publisher (An International Publisher for Academic and Scientific Resources)
More informationTripler Army Medical Center Obstetric Anesthesia Service - FAQs
Tripler Army Medical Center Obstetric Anesthesia Service - FAQs What is a labor epidural? A labor epidural is a thin tube (called an epidural catheter) placed in a woman s lower back by an anesthesia provider.
More informationMaternal hypotension is a common side effect
The Effects of Crystalloid and Colloid Preload on Cardiac Output in the Parturient Undergoing Planned Cesarean Delivery Under Spinal Anesthesia: A Randomized Trial Perumal Tamilselvan, FRCA* Roshan Fernando,
More informationCrystalloid prehydration versus cohydration for prevention of hypotension during spinal anaesthesia for elective caesarean section
Original article Crystalloid prehydration versus cohydration for prevention of hypotension during spinal anaesthesia for elective caesarean section A Sharma 1, PK Gupta 2, SN Singh 3, D Uprety 4 1 Anaesthesiologist,
More informationUpdate Update on Anaesthesia for c-section Dr Kerry Litchfield Consultant Anaesthetist Princess Royal Maternity Glasgow, Scotland
Update Update on Anaesthesia for c-section Dr Kerry Litchfield Consultant Anaesthetist Princess Royal Maternity Glasgow, Scotland Caesarean section is the most common surgical procedure in the world 1
More informationAnesthesia and You. Planning Your Childbirth
Anesthesia and You Planning Your Childbirth Anesthesia Options for Labor and Delivery There are many medications available to women during labor and childbirth. However, some pain relief choices may be
More informationSuccess going from failure to failure without loss of enthusiasm
Success going from failure to failure without loss of enthusiasm Failure of neuraxial analgesia: factors within & beyond our control tips, trick & solutions science, evidence & guidance Dr Matt Wilson
More informationPROPHYLACTIC ORAL EPHEDRINE IN PREVENTION OF HYPOTENSION FOLLOWING SPINAL ANAESTHESIA R. Vasanthageethan 1, S. Ramesh Kumar 2, Ilango Ganesan 3
PROPHYLACTIC ORAL EPHEDRINE IN PREVENTION OF HYPOTENSION FOLLOWING SPINAL ANAESTHESIA R. Vasanthageethan 1, S. Ramesh Kumar 2, Ilango Ganesan 3 HOW TO CITE THIS ARTICLE: R. Vasanthageethan, S. Ramesh Kumar,
More informationWHS POSTOPERATIVE POWERPLAN CHANGES
Medications simplified and standardized to improve safety and effectiveness in the management of pain, itching, nausea/vomiting. Management: o The Anesthesiologist will continue to manage pain in the PACU.
More informationOriginal Article Comparison of prophylactic bolus norepinephrine and phenylephrine on hypotension during spinal anesthesia for cesarean section
Int J Clin Exp Med 2017;10(8):12315-12321 www.ijcem.com /ISSN:1940-5901/IJCEM0057154 Original Article Comparison of prophylactic bolus norepinephrine and phenylephrine on hypotension during spinal anesthesia
More informationNeuraxial anesthesia for scoliosis and previous spinal surgery in pregnancy
O B S T E T R I C A N A E S T H E S I A Tutorial 350 Neuraxial anesthesia for scoliosis and previous spinal surgery in pregnancy Dr. Isabella Rossi Anesthesiology resident, Barnes-Jewish Hospital, USA
More informationThe intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia
The intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia This study has been published: The intensity of preoperative pain is directly correlated
More informationPharmacologic Pain Relief: It s Use in Labor. Linda Robinson MSN, RNC Clinical Nurse Specialist, Northwest Hospital Spring, 2016
Pharmacologic Pain Relief: It s Use in Labor Linda Robinson MSN, RNC Clinical Nurse Specialist, Northwest Hospital Spring, 2016 Objectives Recognize common medications used in the management of labor pain
More informationAbstract. Ahmed Gamassy and Ayad Saleh
Comparison between two phenylephrine infusion rates with moderate co-loading for the prevention of spinal anaeshtesia- induced hypotension during elective caesarean section * Tarek Ansari, Medhat M. Hashem,
More informationSpinal anesthesia without hypotension a myth or reality?
Spinal anesthesia without hypotension a myth or reality? Peter Poredoš, MD, PhD, DESA peter.poredos@kclj.si University Medical Centre Ljubljana, Slovenia Department for Anesthesiology and Intensive Care
More informationOBSTETRICS Effects of intrathecal and i.v. small-dose sufentanil on the median effective dose of intrathecal bupivacaine for Caesarean section
British Journal of Anaesthesia 98 (6): 792 6 (2007) doi:10.1093/bja/aem101 Advance Access publication May 3, 2007 OBSTETRICS Effects of intrathecal and i.v. small-dose sufentanil on the median effective
More informationGUIDELINE FOR THE POST OPERATIVE MANAGEMENT OF WOMEN WHO HAVE RECEIVED INTRATHECAL OR EPIDURAL OPIOID ANALGESIA FOR CAESAREAN SECTION
GUIDELINE FOR THE POST OPERATIVE MANAGEMENT OF WOMEN WHO HAVE RECEIVED INTRATHECAL OR EPIDURAL OPIOID ANALGESIA FOR CAESAREAN SECTION Originator: Maternity Services & Anaesthetics Dept Date Approved: January
More informationInternational Journal of Drug Delivery 5 (2013) Original Research Article
International Journal of Drug Delivery 5 (2013) 239-244 http://www.arjournals.org/index.php/ijdd/index Original Research Article ISSN: 0975-0215 Comparative study of duration of analgesia with epidural
More informationOriginal Article The spread of spinal anesthesia in term parturient: effect of hip/shoulder width ratio and vertebral column length
Int J Clin Exp Med 2016;9(11):21562-21567 www.ijcem.com /ISSN:1940-5901/IJCEM0028307 Original Article The spread of spinal anesthesia in term parturient: effect of hip/shoulder width ratio and vertebral
More informationThe Labour Epidural: Troubleshooting
O B S T E T R I C A N A E S T H E S I A Tutorial 366 The Labour Epidural: Troubleshooting Dr Charlotte Kingsley Anaesthetic Registrar, Royal Free Hospital, UK Dr Alan McGlennan Consultant Anaesthetist,
More informationPre-medication with controlled-release oxycodone in the management of postoperative pain after ambulatory laparoscopic gynaecological surgery
Page 1 of 5 Anaesthetics & Critical Care Pre-medication with controlled-release oxycodone in the management of postoperative pain after ambulatory laparoscopic gynaecological surgery B Lim 1, SY Thong
More informationA 5-Year Audit of Accidental Dural Punctures, Postdural Puncture Headaches, and Failed Regional Anesthetics at a Tertiary-Care Medical Center
Research Article TheScientificWorldJOURNAL (2009) 9, 715 722 ISSN 1537-744X; DOI 10.1100/tsw.2009.94 A 5-Year Audit of Accidental Dural Punctures, Postdural Puncture Headaches, and Failed Regional Anesthetics
More informationI. Chien, I.C. Lu, F.Y. Wang, et al airway management [9]. An examination of a patient s back for spinal landmarks was reported to be a better predict
SPINAL PROCESS LANDMARK AS A PREDICTING FACTOR FOR DIFFICULT EPIDURAL BLOCK: A PROSPECTIVE STUDY IN TAIWANESE PATIENTS I Chien, I-Chen Lu, Fu-Yuan Wang, Lee-Ying Soo, Kwong-Leung Yu, and Chao-Shun Tang
More informationCOMPARISON OF INCREMENTAL SPINAL ANAESTHESIA USING A 32-GAUGE CATHETER WITH EXTRADURAL ANAESTHESIA FOR ELECTIVE CAESAREAN SECTION
British Journal of Anaesthesia 1991; 66: 232-236 COMPARISON OF INCREMENTAL SPINAL ANAESTHESIA USING A 32-GAUGE CATHETER WITH EXTRADURAL ANAESTHESIA FOR ELECTIVE CAESAREAN SECTION I. G. KESTIN, A. P. MADDEN,
More informationAn Epidural Initial Dose is Unnecessary in Combined Spinal Epidural Anesthesia for Caesarean Section
Original An Epidural Initial Dose is Unnecessary in Combined Spinal Epidural Anesthesia for Caesarean Section Takashi Hongo, Akira Kitamura, Motoi Yokozuka, Chol Kim and Atsuhiro Sakamoto Department of
More informationThe Croatian viewpoint for labour analgesia and anaesthesia
Spring Congres of the Finish Society of Anaesthesiologist (Obstetric Anaesthesia branch, SOAT) The Croatian viewpoint for labour analgesia and anaesthesia Dragica Kopic,MD, Department of Anaesthesiology
More informationCase Report Caesarean Delivery Complicated by Unintentional Subdural Block and Conversion Disorder
Case Reports in Medicine Volume 2013, Article ID 751648, 4 pages http://dx.doi.org/10.1155/2013/751648 Case Report Caesarean Delivery Complicated by Unintentional Subdural Block and Conversion Disorder
More informationMAT IN PREGNANCY KAYLA LIFE STAGE 1: ADOLESCENCE LIFE STAGE 2: EARLY ADULTHOOD. family History of addiction. addiction to oral opioids
MAT IN PREGNANCY R. COREY WALLER MD, MS PRINCIPAL, HEALTH MANAGEMENT ASSOCIATES FACULTY, INSTITUTE FOR HEALTHCARE INNOVATION (IHI) CHAIR, LEGISLATIVE ADVOCACY COMMITTEE, ASAM KAYLA LIFE STAGE 1: ADOLESCENCE
More informationAnesthesia for Total Hip and Knee Arthroplasty
Anesthesia for Total Hip and Knee Arthroplasty Typical approach Describe anesthesia technique Rather Describe issues with THA and TKA How anesthesia can modify Issues Total Hip Total Knee Blood Loss ++
More informationIntravenous lidocaine infusions. Dr Ian McConachie FRCA FRCPC
Intravenous lidocaine infusions Dr Ian McConachie FRCA FRCPC Thank the organisers for inviting me. No conflicts or disclosures Lidocaine 1 st amide local anesthetic Synthesized in 1943 by Lofgren in Sweden.
More informationAnesthesiology in advanced radical surgery. Bruno Carrara Ospedali Riuniti di Bergamo
Anesthesiology in advanced radical surgery Bruno Carrara Ospedali Riuniti di Bergamo Anesthetic considerations Anesthesiology in advanced radical surgery Anesthesiologists's task is to minimize the contribution
More informationMitra et al. Sri Lankan Journal of Anaesthesiology: 23(2):61-65(2015) DOI: /slja.v23i2.8068
DOI: 10.4038/slja.v23i2.8068 Evaluation of analgesic efficacy of the combination of fentanyl with low dose bupivacaine vs ropivacaine using patient controlled epidural analgesia for control of labour pain-
More informationHow to reduce failure rate of regional anaesthesia for caesarean section? Mike Kinsella St Michael s Hospital, Bristol 4 th November 2010
How to reduce failure rate of regional anaesthesia for caesarean section? Mike Kinsella St Michael s Hospital, Bristol 4 th November 2010 Define failure GA conversion; RCoA standards Cat 4
More informationCesarean delivery is a common intervention performed
Continuous Ropivacaine Subfascial Wound Infusion Compared With Intrathecal Morphine for Postcesarean Analgesia: A Prospective, Randomized Controlled, Double-Blind Study Manon Lalmand, MD,* Madeleine Wilwerth,
More informationEfficacy of postoperative epidural analgesia Block B M, Liu S S, Rowlingson A J, Cowan A R, Cowan J A, Wu C L
Efficacy of postoperative epidural analgesia Block B M, Liu S S, Rowlingson A J, Cowan A R, Cowan J A, Wu C L CRD summary This review evaluated the efficacy of post-operative epidural analgesia. The authors
More informationAnesthesia: Essays and Researches
A E R Editor in Chief : Mohamad Said Maani Takrouri (KSA) Open Access HTML Format For entire Editorial Board visit : http://www.aeronline.org/editorialboard.asp Anesthesia: Essays and Researches Original
More informationMedication-assisted opioid addiction treatments: OB/GYN
5/13/16se Medication-assisted opioid addiction treatments: OB/GYN In October 2002, the Food and Drug Administration (FDA) approved buprenorphine monotherapy product, Subutex, and a buprenorphine/naloxone
More informationCOMPARATIVE STUDY OF HEMODYNAMIC EFFECTS OF CRYSTALLOID PRELOADING VERSUS COLOADING DURING SPINAL ANAESTHESIA FOR CAESAREAN SECTION
[VOLUME 4 I ISSUE 4 I OCT. DEC 2017] e ISSN 2348 1269, Print ISSN 2349-5138 http://ijrar.com/ Cosmos Impact Factor 4.236 COMPARATIVE STUDY OF HEMODYNAMIC EFFECTS OF CRYSTALLOID PRELOADING VERSUS COLOADING
More information