Tongue necrosis in temporal arteritis provoked by ergotamine.

A case of tongue necrosis in a patient with temporal arteritis who was taking ergotamine is described, and the role of ergotamine tartrate in provoking the tongue necrosis is considered. The literature on this unusual complication is critically reviewed, and the value of a carotid angiography in assessing the tongue ischaemia is exemplified.

Fetal blood flow during intrathecal anaesthesia for elective caesarean section.

Fetal aortic and umbilical blood flows were studied in 15 mothers before and during spinal (intrathecal) anaesthesia for elective Caesarean section, using a method combining real-time ultrasonography and a pulsed Doppler technique. Spinal anaesthesia with 0.5% bupivacaine hydrochloride 2.5 ml in 8% glucose monohydrate solution was administered after preloading with 2 litre of lactated Ringer's solution. Simultaneously with the subarachnoid injection, an infusion i.v. of ephedrine 50 mg in 500 ml normal saline was initiated. Maternal heart rate and systolic arterial pressure remained stable during the spinal anaesthesia, but diastolic arterial pressure decreased (P less than 0.05). Fetal heart rate increased (P less than 0.05) 30 min after the introduction of the spinal anaesthesia, but blood flows in the fetal descending aorta and umbilical vein were unaffected. The pulsatility index of the fetal blood velocity decreased (P less than 0.05) both in the fetal aorta and in the umbilical artery 30 min after induction of the spinal anaesthesia, indicating a possible decrease in the placental vascular resistance. We conclude that, when normotension is maintained in the mother with a preload infusion and an infusion of ephedrine, spinal anaesthesia for Caesarean section has no harmful effect on the fetal circulation.

Effects of extradural anaesthesia on human fetal blood flow in utero. Comparison of three local anaesthetic solutions.

Twenty-seven women, scheduled for elective Caesarean section under extradural anaesthesia were allocated randomly to one of three groups: group Ea received 1.5% etidocaine with adrenaline, group Bp 0.5% bupivacaine plain, and group Ba 0.5% bupivacaine with adrenaline. There was no difference in the quality and distribution of sensory blockade between the three groups. Motor blockade was most profound in group Ea. Maternal heart rate and arterial pressure were only slightly affected in the three groups. Before induction of extradural anaesthesia, and 15 and 30 min after, fetal umbilical and aortic blood flows were examined using a combination of real-time ultrasonography and the pulsed Doppler technique. Blood flow in the umbilical vein was not affected in any of the groups, and blood flow in the fetal aorta remained unchanged in groups Ea and Bp, but was increased by 12% after 30 min in group Ba. We conclude that, with the three local anaesthetic solutions studied during extradural anaesthesia for elective Caesarean section, fetal circulatory variables remained stable and within normal limits, when in association with normal values of maternal arterial pressure.

Obstetric analgesia and fetal aortic blood flow during labour.

Fetal aortic blood flow was studied in 50 women during labour, using a method combining real-time ultrasonography and a pulsed Doppler technique. Eleven women had no analgesia, 24 women received 75-100 mg pethidine intramuscularly, 12 epidural analgesia with 0.25% bupivacaine and three paracervical block with 0.125% bupivacaine. Fetal aortic blood flow increased during labour from 200 to 245 ml/min/kg in the group without analgesia (P less than 0.05) and from 211 to 236 ml/min/kg in the group with epidural analgesia (P less than 0.05) but decreased insignificantly from 216 to 204 ml/min/kg after pethidine. After paracervical block the aortic blood flow fell in two out of three fetuses. Not only is epidural analgesia the most effective means of pain relief during labour, it is also the type of obstetric analgesia that interferes least with the physiological response to labour in terms of its effect on the fetal blood flow.

Pollution of delivery ward air by nitrous oxide. Effects of various modes of room ventilation, excess and close scavenging.

According to a survey to all Swedish delivery departments, nitrous-oxide-oxygen analgesia given on demand is frequently used by women in labour. Excess gas scavenging equipment was lacking in 12 out of a total of 73 delivery wards in September 1982. The effects of various room ventilation and excess gas scavenging methods on the nitrous oxide concentration in the delivery room were investigated. The 8 h time weighted average (TWA) for midwives was 24 ppm nitrous oxide with room ventilation in accordance with the Swedish recommended standard and with excess gas scavenging using 1.61 reservoir tube volume. For women in labour, close scavenging using various modifications of conventional tube systems was shown to be practically impossible to apply. Close scavenging via a specially designed plastic hood surrounding the face of the woman in labour resulted in very low nitrous oxide concentrations in the delivery room, even when the room ventilation was reduced to very low values.