Epidural ropivacaine 7.5 mg/ml for elective Caesarean section: a double-blind comparison of efficacy and tolerability with bupivacaine 5 mg/ml.

BACKGROUND: Ropivacaine is a new local anaesthetic drug known to be less cardiotoxic than bupivacaine. The aims of this comparative study with bupivacaine were to evaluate efficacy, safety and tolerability for the mother and the neonate when using ropivacaine 7.5 mg/ml for epidural anaesthesia for elective Caesarean section. METHODS: In a double-blind, multicentre trial the patients were randomised to receive 20 ml of either ropivacaine 7.5 mg/ml or bupivacaine 5 mg/ml. The quality of the peroperative analgesia and abdominal muscle relaxation as well as tolerability and safety in both the mother and the neonate were evaluated. RESULTS: A total of 122 patients were evaluated for efficacy and tolerability. There were no significant differences in the onset time and the extent of the sensory spread or motor block. The peroperative quality of anaesthesia and muscle relaxation was similar in both groups. No significant side effects were observed, except for a more profound drop in systolic blood pressure in the ropivacaine group. The anaesthetics were well tolerated by the neonate in both groups, evaluated by Apgar and NACS scores. CONCLUSION: Ropivacaine 7.5 mg/ml administered epidurally resulted in equally effective anaesthesia for Caesarean section as bupivacaine 5 mg/ml. Because of the lower cardiotoxicity of ropivacaine, the new amide has a potential in replacing bupivacaine when used epidurally for Caesarean section.

Fetal heart rate decelerations and umbilical cord blood gas values.

Although fetal heart rate (FHR) monitoring is widely used for fetal surveillance, there is still disagreement about the value of cardiotocography and the interpretation of FHR patterns. We addressed this in a prospective study in which umbilical cord blood gas and pH values at the time of cesarean section were related to different FHR patterns classified prior to surgery. The patient population consisted of 56 pregnant women with singleton fetuses of gestational age between 37 and 43 weeks. Indication for cesarean section was late FHR decelerations in 16 cases and variable decelerations in 17. Twenty-three patients operated on electively, and without any FHR abnormalities, served as a reference group. Late FHR decelerations were associated with the lowest pH and PO2 levels in arterial as well as in venous blood. In the group with variable decelerations, the umbilical vein PO2 was similar to that of the reference group, whereas the PO2 value in the artery was significantly lower. Hence, in this clinical study a clear relationship was found between the different FHR patterns and changes in the acid-base balance.

[HELLP syndrome--4 case reports]. / HELLP-syndromet--fire kasuistikker.

HELLP-syndrome (H - haemolysis, EL - elevated liver enzymes, LP - low platelet count) is a serious complication of pregnancy. It can be considered as a variant of severe preeclampsia, where haemolysis, hepatic damage (elevated liver enzymes) and thrombocytopenia (low platelets) are all present. Four case reports of HELLP-syndrome are described. HELLP-syndrome may develop within a few hours. It can be seen pre-, intra- and postpartum. Many patients do not exhibit a clinical picture of severe preeclampsia. Patients who develop HELLP-syndrome usually complain of malaise, nausea, epigastric pain and headache. The diagnosis is confirmed when haemolysis, elevated liver enzymes and thrombocytopenia are demonstrated. Patients with HELLP-syndrome require intensive care by a team of obstetricians, anaesthesiologists and haematologists.

The Cronkhite-Canada syndrome. Case report.

Polyps of the stomach, duodenum, colon and rectum were found in a 53-year-old man, who had severe diarrhoea, heavy protein loss from the gastrointestinal tract and shedding of hair and nails. The patient died after 9 months of treatment with drugs and periodic intravenous nutrition.

Postoperative pain relief with high-dose epidural buprenorphine: a double-blind study.

Forty-five patients scheduled for major abdominal or intrathoracic surgery were assigned at random to two different groups. One group received 0.3 mg and the other 0.9 mg of buprenorphine epidurally to abolish postoperative pain. The first dose was given immediately upon arrival in the ICU, irrespective of pain. Subsequent medication was given on demand. The duration of action and side-effects were recorded. Both doses produced excellent and long-lasting pain relief, but no statistically significant difference was found between the groups, with regard to either the duration of action or the occurrence of side-effects.

Effect of pirenzepine and antacids on postprandial intragastric pH.

Peptic ulcer treatment with high dose regimens of antacids may be inconvenient and unpleasant, and the risk of side effects should not be neglected. Anticholinergics are claimed to accentuate and prolong the effect of antacids on intragastric acidity. In the study the effect on postprandial intragastric pH of a moderate dose of antacids in combination with pirenzepine was compared with that of a double dose of antacids in six healthy subjects, to see whether the dose of antacids could be reduced when given in combination with an antimuscarinic compound. Doubling the dose of antacids caused higher pH peaks while adding pirenzepine caused a more sustained pH elevation. The curves showing the percentage of pH readings greater than or equal to each pH level were almost identical up to pH 4. The results support the rationale of using antacids and pirenzepine in combination.

The Christiansen hip prosthesis preliminary results.

The combined endo- and total hip prosthesis of Christiansen is described. In this prosthesis an articular connection, or trunnion bearing, is introduced between the head and stem components in order to reduce friction at the acetabular joint. The stem portions of both prostheses are identical. The endoprosthesis was inserted in 50 patients, who were followed-up during one year. The results were according to the classification of Love (Surg. Clin. N. Amer., 1963, 43, p. 1217): excellent in 60%, good in 22%, and poor in 18% of cases. In addition some results from other Norwegian hospitals were presented.