ABSTRACT
A prospective study of 79 fit young adults who underwent oral dental surgery was undertaken with five different anaesthetic techniques. Anaesthesia was commenced with methohexitone or flunitrazepam, muscle relaxants, and cuffed nasal intubation, and anaesthesia was maintained with 50% nitrous oxide, 50% oxygen, halothane or fentanyl with or without intermittent positive pressure ventilation (IPPV). Six of the 33 patients who received methohexitone and halothane developed dangerous dysrhythmias. Flunitrazepam, IPPV, adequate analgesia and anaesthesia provide maximum cardiovascular stability.
Subject(s)
Anesthesia, Dental , Anesthesia, General , Arrhythmias, Cardiac/chemically induced , Heart Rate/drug effects , Adult , Anesthesia, Dental/methods , Anesthesia, General/methods , Blood Pressure/drug effects , Carbon Dioxide , Female , Fentanyl/pharmacology , Flunitrazepam/pharmacology , Halothane/pharmacology , Humans , Intermittent Positive-Pressure Ventilation , Male , Methohexital/pharmacology , Pancuronium/pharmacology , Stimulation, Chemical , Succinylcholine/pharmacology , Tooth Extraction/methodsSubject(s)
Anesthesia, Inhalation/methods , Anesthesia, Obstetrical/methods , Cesarean Section , Enflurane , Female , Humans , PregnancyABSTRACT
Thirty mothers undergoing elective Caesarean section received thiopentone 3.5 mg kg-1 and 30 received etomidate 0.3 mg kg-1 for induction of anaesthesia. Subsequent management of anaesthesia was identical in both groups. Maternal to fetal base excess differences and the degree of biochemical correlation between mother and infant were more favourable following etomidate than following thiopentone. The clinical status of the newborn was considered superior with etomidate.
Subject(s)
Anesthesia, Intravenous , Anesthesia, Obstetrical , Cesarean Section , Etomidate , Imidazoles , Thiopental , Adult , Female , Humans , PregnancyABSTRACT
A hypothesis that volatile anaesthetic agents, represented by enflurane, facilitate transplacental exchange was tested by simultaneous blood sampling of both mother and fetus. A trend towards improved fetal scalp blood gas status and maternal-to-fetal acid-base matching was observed with enflurane. Our results encourage further research into the feasibility of intra-uterine fetal resuscitation by anaesthetically induced promotion of intervillous perfusion.
Subject(s)
Anesthesia, Obstetrical , Enflurane/pharmacology , Maternal-Fetal Exchange/drug effects , Methyl Ethers/pharmacology , Acid-Base Equilibrium/drug effects , Adolescent , Adult , Anesthesia, Inhalation , Blood Gas Analysis , Blood Pressure/drug effects , Carbon Dioxide/blood , Clinical Trials as Topic , Female , Fetal Blood/analysis , Humans , Hydrogen-Ion Concentration , Nitrous Oxide , Oxygen/blood , Pregnancy , Pulse/drug effectsABSTRACT
Anaesthesia for caesarean section demands a technique that provides perfect narcosis without neonatal depression. To date, no ideal induction agent has been found for obstetric anaesthesia, although thiopentone is still considered the safest. A new agent, etomidate (0,3 mg/kg) has been studied in a group of parturients who underwent elective caesarean section in the left lateral tilt position. The results obtained are compared with those from a similar series, in which the management was identical, except that anaesthesia was induced with thiopentone 3,5 mg/kg. The infants in the present series were usually extremely lively after delivery, and generally sustained respiration in a shorter time than those after thiopentone. In addition, maternal-to-fetal base excess gradients were narrower with etomidate than with thiopentone. Thus etomidate may offer some advantage over thiopentone for anaesthetic induction at elective caesarean section, and appears worthy of further trial.
Subject(s)
Anesthesia, Obstetrical , Cesarean Section , Etomidate , Imidazoles , Thiopental , Anesthesia, Intravenous , Blood Chemical Analysis , Female , Fetal Blood/analysis , Humans , Placenta , PregnancyABSTRACT
Thiopentone (3,5 mg/kg) was compared with methohexitone (1 mg/kg) and 'low-dose' ketamine (1 mg/kg) for induction of obstetric anaesthesia. Anaesthesia was maintained with gas, oxygen, muscle relaxant and 0.6% enflurane. Fetal oxygenation was superior with thiopentone, but blood gas/acid base status was otherwise comparable among the different agents. Methohexitone and low-dose ketamine appear to offer reasonable alternatives to thiopentone for anaesthetic induction at caesarean section.
Subject(s)
Anesthesia, Obstetrical , Cesarean Section , Ketamine , Methohexital , Thiopental , Acid-Base Equilibrium , Adult , Blood Gas Analysis , Carbon Dioxide , Depression, Chemical , Female , Fetal Blood/analysis , Humans , Hydrogen-Ion Concentration , Maternal-Fetal Exchange , Oxygen , PregnancyABSTRACT
We have attempted to update a previous review of the hazards and problems confronting the mother, fetus and anaesthetist at caesarean section. A recent survey of obstetric anaesthesia within the Republic and South West Africa indicates that a significant proportion of anaesthetic services for midwifery are provided by non-specialist practitioners in hospitals outside major population centres. We believe that both mothers and their infants will gain from the careful perusal by their doctors of this review.
Subject(s)
Anesthesia, Obstetrical/methods , Cesarean Section , Anesthesia, General/methods , Anesthesia, Spinal/methods , Female , Humans , Postoperative Period , Preanesthetic Medication , PregnancyABSTRACT
In this report we analyse the results of a questionaire sent to 341 hospitals throughout the Republic and South West Africa, asking for details of their caesarean section rate and obstetric anesthetic techniques used. Non-specialist practitioners provided 90% of anaesthetic services in the 131 (38,4%) hospitals from which replies were received. General anaesthesia was used in preference to regional anaesthesia in 90% of these hospitals. Of the institutions surveyed, 24% used neither stomach emptying nor antacid therapy pre-operatively. These and other results pertaining to their choice of anaesthetic agents and techniques are presented and discussed.
Subject(s)
Anesthesia, Obstetrical , Cesarean Section , Anesthesia, Conduction , Anesthesia, General , Female , Humans , Namibia , Preanesthetic Medication , South AfricaABSTRACT
The relative merits of right and left lateral tilt were assessed in 75 parturients at elective caesarean section. Significant maternal hypotension (aortocaval occlusion) occurred more frequently with rightward tilt (left hip supported). The clinical and biochemical status of the fetus was generally more favourable with left lateral tilt, as were the maternal-to-fetal blood gas gradients and relationships. The routine use of left lateral tilt is advocated.
Subject(s)
Cesarean Section/methods , Adult , Blood Gas Analysis , Blood Pressure , Female , Humans , Maternal-Fetal Exchange , PregnancyABSTRACT
Supplementation of general anaesthesia with enflurane 0.6% before delivery of the foetus by elective Caesarean section, produced contrasting effects after methohexitone and ketamine administration. Enflurane, an inhalational agent causing vasodilation and uterine relaxation, enhanced maternal to foetal transplacental exchange following methohexitone induction of narcosis. This beneficial effect of the volatile agent was not seen after ketamine, a vasoconstrictor drug which stimulates myometrial contraction.
Subject(s)
Anesthesia, Obstetrical , Cesarean Section , Enflurane/pharmacology , Ketamine/pharmacology , Maternal-Fetal Exchange/drug effects , Methohexital/pharmacology , Methyl Ethers/pharmacology , Adult , Blood Gas Analysis , Drug Interactions , Female , Humans , PregnancyABSTRACT
In 60 mothers with normal placental function, the relative merits of right and left lateral tilt during Caesarean section were assessed. Maternal-foetal biochemical values and relationships were generally more satisfactory with the left lateral position. The incidence of hypotension (revealed aorto-caval occlusion) before and after induction of anaesthesia, was significantly greater (P less than 0.001) with the "right side down" posture.
