EPIDURAL ANALGESIA FOR CAESAREAN SECTION: A Review of 182 Cases

Milne, M.K.; Lawson, J.I.M.

doi:10.1093/bja/45.12.1206

Cited by 16 publications

(8 citation statements)

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“…Usually it was of brief duration, but one patient was nauseated throughout the procedure. This high incidence of nausea is much greater than that reported by other authors avoiding ergometrine; Milne and Murray Lawson (1973) noted an incidence of nausea associated with oxytocin of only 2 % . It is difficult to explain the large differences in incidence of nausea.…”

Section: Discussioncontrasting

confidence: 56%

“…Only 2 in the present series (3.3%) requested a general anaesthetic during the procedure. This compares favourably with Shnider ( 1970) where general or "light anaesthesia" was required in 10% of cases in order to allow surgery to continue and Milne and Murray Lawson (1973) where 7.7 % required general anaesthesia. Nevertheless only a minority of patients in this series were comfortable enough to require no additional medication (other than atropine and an oxytocic).…”

Section: Discussionmentioning

confidence: 57%

“…Other authors (Forthman and Adriani 1957, Moya and Smith 1962, Milne and Murray Lawson 1973, Magno et al 1976, James et al 1977 noted hypotension in from 16% to 82% of patients despite institution of some or all of the forementioned prophylactic measures. It should be stressed however that these authors have used different definitions of hypotension and are not therefore comparable.…”

Section: Hypotensionmentioning

confidence: 98%

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Central Neural Blockade and Caesarian: Section. Part 1: Review and Case Series.

Brownridge¹

1979

Anaesth Intensive Care

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 57%

Section: Hypotensionmentioning

confidence: 98%

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Central Neural Blockade and Caesarian: Section. Part 1: Review and Case Series.

Brownridge¹

1979

Anaesth Intensive Care

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“…Over the three decades following the initial report by Milne et al, 17 several studies [6][7][8][9][10][11][12][13][14][15] described retrospective reviews of the anesthesia for intrapartum CD in parturients receiving ELA. Unfortunately, when the attempted conversion resulted in inadequate ESA, none of these studies focused on the anesthetic management in an attempt to identify interventions to potentially reduce the need for GA.…”

Section: Discussionmentioning

confidence: 99%

Conversion d’une analgésie péridurale pour travail obstétrical en une anesthésie péridurale pour césarienne

Campbell

Tran

2008

Can J Anesth/J Can Anesth

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Purpose To determine the rate of successful conversion of epidural labour analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum Cesarean delivery (CD) with identification of potential risk factors for inadequate ESA. Secondary outcomes include a comparison of the management by subspecialist obstetric anesthesiologists (OB) vs. generalist anesthesiologists (GEN), when inadequate ESA was encountered, with an intention of identifying potential interventional strategies to reduce the need for general anesthesia (GA). Methods Health records of all parturients who received ELA and who underwent intrapartum CD during the 3-year period from April 01, 2001 to March 31, 2004 were manually reviewed. Data were analyzed using t test, Chisquare, Fisher's exact test, and analysis of variance where appropriate. A P \ 0.05 was considered significant. Results Eight hundred ninety-nine cases were identified. Four were excluded, as two received continuous spinal labour analgesia and two underwent emergency CD with insufficient time for conversion to ESA. Initially, 86.6% (775/895) of the 895 cases were successfully converted to ESA leaving 120 cases of inadequate ESA, 36 of these were managed by OB and 84 by GEN. Ineffective ELA was identified as a risk factor for unsuccessful conversion. Pulling the epidural catheter back 1 cm was identified as an effective intervention that resulted in the successful conversion in [80% of the 120 cases of inadequate ESA.Spinal anesthesia proved effective in 75% of cases. Both interventions reduced the need for GA to 1.2% for OB and 5.6% for GEN. Conclusions This investigation provides anesthesiologists with strategies to manage inadequate ESA for intrapartum CD that may reduce the need for GA.

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“…The incidence of vomiting is not always recorded by other authors, but has been recorded to be as high as 440,;. 6 In our hospital 735, of patients undergoing elective Caesarean section choose epidural analgesia. The subject of anaesthesia is discussed with those patients who are to be delivered by elective Caesarean section by their obstetricians at the antenatal clinic, and after admission to hospital for operation, they are encouraged to talk to other patients who have had a Caesarean section under epiduial analgesia.…”

Section: It Has Beenmentioning

confidence: 63%

Epidural analgesia for elective Caesarean section

Thorburn

Moir

1980

Anaesthesia

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SummaryA technique is described of epidural anaesthesia for elective Caesarean section which has a 987; success rate, and an acceptably low incidence of intra-operative pain. The essentials of the technique are to produce and maintain complete sensory block from SS to T6, employing a two-stage injection of bupivacaine O.S% (mean dose 23 ml) and the use of gravity to ensure sacral block. Despite the use ofpreoperative fluid loading and avoidance of caval occlusion, transitory hypotension occurred in 16% of patients. Vomiting, which occurred in 187; of patients, is a minor but distressing complication. Key wordsAnalgesia; epidural, obstetric.Conduction anaesthesia offers several advantages over general anaesthesia for Caesarean section. The use of epidural analgesia is associated with less fetal depression1*2*3 and higher Apgar scores than those babies delivered by general anaesthesia. It has the further considerable advantage that the mother participates in the birth of her child and the mother/ child bond is established at birth. Epidural analgesia eliminates some of the problems associated with general anaesthesia, the risk of awareness, and the hazards of endotracheal intubation and regurgitation.Our earlier experiences with epidural analgesia were in general agreement with those of others6, in which an unacceptably high incidence of pain occurred necessitating the induction of general anaesthesia or intravenous sedation. This technique has been developed in an attempt to reduce the incidence of undesirable side effects and it has a low failure rate and a high patient and obstetrician satisfaction rate. Anaesthetic techniqueTo be successful, a complete, bilateral sensory block from S5 to T6 must exist and must not be allowed to regress. Manipulation of the pelvic organs which are sacrally innervated occurs during surgery and, in the absence of sacral block, pain is experienced. The essence of the technique is to utilise the effect of gravity by conducting the procedure in two stages, ensuring that the extensive block required for Caesarean section can be achieved with the minimum quantity of local anaesthetic. Sufficient time must be available to achieve the block and attention to every detail is essential.An intravenous infusion of 500 ml of Ringer lactate is given in the 15 min preceding the epidural injection,' followed by 500 ml of J.

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EPIDURAL ANALGESIA FOR CAESAREAN SECTION: A Review of 182 Cases

Cited by 16 publications

References 0 publications

Central Neural Blockade and Caesarian: Section. Part 1: Review and Case Series.

Central Neural Blockade and Caesarian: Section. Part 1: Review and Case Series.

Conversion d’une analgésie péridurale pour travail obstétrical en une anesthésie péridurale pour césarienne

Epidural analgesia for elective Caesarean section

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