ISSN:
1365-2044
Source:
Blackwell Publishing Journal Backfiles 1879-2005
Topics:
Medicine
Notes:
We present here clinical data from 993 patients who were destined to undergo elective Caesarean section under epidural analgesia. In 29 cases the attempt to provide an epidural was abandoned before the operation started. In regard to this, the importance of monitoring the fetal heart rate during initiation of the epidural is emphasised. In 10 cases general anaesthesia was induced after delivery, and in a further 108 cases supplemental analgesia was administered, either systemically, by inhalation or by an additional epidural top-up, after delivery. Satisfactory analgesia throughout the operation was achieved in 87.8%. In an appreciable proportion of cases the recommended maximum dose of bupivacaine, and the recommended maximum rate of bupivacaine administration, were exceeded without apparent complication. There was a tendency for the volume of Hartmann's solution infused intravenously before and during initiation of the epidural to he increased throughout the period under review (1971–85). The prevalence of hypotension diminished during that period. Characteristics of the data did not permit a close analysis of the main factors which could have led to an episode of maternal hypotension. However, it did appear that such an episode could he ascribed to too brief an interval between the first and second, or the second and third top-up doses. The frequency with which blood was transfused during operation was markedly lower than that noted in a concurrent series of elective sections conducted under general anaesthesia. Brief reports of six unusual complications are included and attention is drawn to the prominence of the use of 0.75% bupivacaine in these, and also to the frequency with which use of that solution was associated with unsatisfactory analgesia.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1111/j.1365-2044.1986.tb12751.x
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