ABSTRACT
OBJECTIVE: The purpose of this study was to retrospectively determine the safety and efficacy of epidural anesthesia when administered by obstetricians in a community hospital. STUDY DESIGN: Data containing 14,598 epidural procedures from 31,818 births were obtained from delivery room logs over a period of 20 years, from 1972 through 1991. Data were displayed graphically to view trends over time. Odds ratios were calculated to determine the associations of epidural anesthesia with oxytocin stimulation, episiotomy, assisted vaginal delivery (forceps or vacuum extraction), and cesarean section. Particular scrutiny was given to any listed complication during labor or delivery. RESULTS: Over the 20-year period epidural anesthesia was administered without serious complication by various obstetricians with different training. Technique improved as procedures became standardized, resulting in an increase in the number of epidural procedures over the 20-year period. Incidence was also increased among women requiring oxytocin augmentation, episiotomies, and assisted vaginal deliveries. Of the total number performed, < 5% of patients required additional anesthesia. CONCLUSION: Over a 20-year period epidural analgesia or anesthesia has been an effective and safe procedure when performed and supervised by obstetricians-gynecologists in a community hospital.
Subject(s)
Anesthesia, Epidural , Anesthesia, Obstetrical , Obstetrics , Analgesia, Epidural/adverse effects , Analgesia, Obstetrical/adverse effects , Anesthesia, Epidural/adverse effects , Anesthesia, Obstetrical/adverse effects , Delivery, Obstetric , Female , Humans , Oxytocin/administration & dosage , Pregnancy , Retrospective Studies , Treatment OutcomeABSTRACT
In 22 patients during thoracotomy in the lateral position, the effects of selective positive end-expiratory pressure (PEEP) to the dependent lung while simultaneously ventilating the non-dependent lung at zero end-expiratory pressure (ZEEP) on (1) inspired O2 concentration required to maintain adequate Pao2 during thoractomy and 2) alveolar-arterial oxygen difference (AaO2D) while breathing 100 percent O2 at the end of thoractomy were examined and compared to ventilation of both lungs at ZEEP, Selective PEEP to the dependent lung resulted in adequate PaO2 with a lower inspired O2 concentration (44 +/- SD 6% versus 70 +/- SD 21%), and a smaller AsO2D while breathing 100 percent O2 189 +/- SD 31 versus 342 +/- SD 69 torr) at the end of thoracotomy.
Subject(s)
Oxygen , Positive-Pressure Respiration , Thoracic Surgery , Thorax/surgery , Blood Gas Analysis , Humans , Methods , Middle Aged , Positive-Pressure Respiration/instrumentation , Pressure , Respiration , Ventilation-Perfusion RatioABSTRACT
A study was performed on a series of healthy patients undergoing laparoscopy for tubal ligation with local anesthesia in a non-operating room setting. Ventilatory parameters, blood gas, pH, blood pressure, and pulse were monitored. The results revealed that no adverse effect on hemoglobin saturation or carbon dioxide exchange were found when fentanyl alone was used as a supplementary analgesic. An occasional vagal reflex was observed, and it is recommended that an intravenous line be established in the event that pharmacologic intervention should become necessary. Nitrous oxide produced les with this minimal analgesia.
