ABSTRACT
BACKGROUND AND OBJECTIVES: Although dizziness and drowsiness may be produced with either intravenous or epidural fentanyl, their occurrence after an intravenous injection is more rapid and relatively more pronounced. The purpose of this study was to determine whether or not the difference between routes of administration would be a reliable method of detecting an accidental intravascular injection. METHODS: In part 1, using a double-blinded protocol, we prospectively assessed in laboring women the incidence of dizziness, drowsiness, or both associated with intravenous fentanyl (100 micrograms). In random order, subjects received two peripheral intravenous injections: 2 ml of fentanyl and 2 ml of saline, separated by a 3-minute observation period. RESULTS: In group 1 (18/18) and group 2 (22/22), all subjects reported a response to intravenous fentanyl within the one-minute assessment. In part 2, we evaluated in laboring patients the frequency of dizziness, drowsiness, or both to epidural fentanyl (100 micrograms). The study design was identical to part 1; however, the subjects received 2 ml of fentanyl and 2 ml of saline via a functional epidural catheter. In group 3 (1/18) and group 4 (1/22), one subject reported a response to epidural fentanyl within the 3-minute observation period. CONCLUSIONS: Overall, the responses to intravenous fentanyl (40/40) occurred in a remarkably more consistent fashion when compared to epidural fentanyl (2/40). Thus, the results suggest that in laboring patients, intravenous fentanyl produces predictable and easily detectable changes that may be useful in identifying an epidural catheter unintentionally placed intravascularly.
Subject(s)
Anesthesia, Epidural/methods , Anesthesia, Obstetrical/methods , Fentanyl/administration & dosage , Analgesia, Epidural/methods , Analgesia, Obstetrical/methods , Bupivacaine/administration & dosage , Double-Blind Method , False Positive Reactions , Female , Fentanyl/adverse effects , Humans , Injections, Epidural , Injections, Intravenous , Pregnancy , Prospective StudiesSubject(s)
Anesthesia, Epidural/adverse effects , Anesthesia, Obstetrical/adverse effects , Catheterization/adverse effects , Adult , Anesthesia, Epidural/methods , Anesthesia, Obstetrical/methods , Anesthetics/adverse effects , Cesarean Section , Epidural Space , Female , Humans , Infant, Newborn , Pregnancy , Seizures/chemically inducedABSTRACT
The authors evaluated the antiemetic properties of transdermal scopolamine (TDS) in healthy patients undergoing elective cesarean section and receiving epidural morphine for postoperative analgesia. Prior to administration of anesthesia, 203 patients had either TDS or a placebo study patch applied behind one ear. All patients were hydrated with lactated Ringer's solution iv and given 2.0% lidocaine with 1:200,000 epinephrine epidurally for surgical anesthesia. Following delivery of the infant, 4 mg of morphine sulphate was injected through the epidural catheter. After the operation patients were evaluated by "blinded" observers at 2, 4, 6, 8, 10, 24, and 48 h for nausea, vomiting, retching, pain relief, itching, and adverse effects. In addition, medications received were noted. No differences were found between the groups in terms of severity or incidence of pain, or requests for analgesic or antipruritic medication. Although there was no difference between the groups in the first 2 h, patients with TDS had significantly less nausea, vomiting, and retching than patients in the placebo group in each time interval between 2 and 10 h. Additionally, the TDS group required less antiemetic medication. There was no difference in the frequency of retching or vomiting between groups. Side effects were minimal and equal in both groups. The authors conclude that TDS results in a decreased incidence of nausea and vomiting in patients who have delivered by cesarean section and received epidural morphine. TDS appears safe for continuous antiemetic administration.
Subject(s)
Analgesia, Epidural , Cesarean Section , Morphine/therapeutic use , Nausea/prevention & control , Scopolamine/administration & dosage , Vomiting/prevention & control , Administration, Cutaneous , Adolescent , Adult , Female , Humans , Pain, Postoperative/drug therapy , Postoperative Complications/prevention & control , Pregnancy , Scopolamine/therapeutic useABSTRACT
Charts from 2929 consecutive parturients were reviewed. Twenty-four had platelet counts less than 100,000/microL in the peripartum period. Seventeen of the 24 had predisposing causes for thrombocytopenia, including preeclampsia (nine), immune thrombocytopenia purpura (two), infection (three), placenta accreta (one), abruption (one), and excessive surgical bleeding (one). Seven had asymptomatic thrombocytopenia of unknown origin. Fourteen of the 24 thrombocytopenic patients received regional anesthesia, and none had permanent sequelae. Based upon this retrospective review, peripartal thrombocytopenia (15,000-99,000/microL) did not increase the risk of neurologic complications after a regional anesthetic. There have been no reports in the literature of spinal or epidural hematomas in parturients after regional anesthesia, except for one patient with a spinal ependymoma.
