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Obstetric local anesthetic toxicity

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https://www.readbyqxmd.com/read/24961586/major-complications-of-epidural-anesthesia-a-prospective-study-of-5083-cases-at-a-single-hospital
#1
X-H Kang, F-P Bao, X-X Xiong, M Li, T-T Jin, J Shao, S-M Zhu
BACKGROUND: We undertook a prospective study of non-obstetric epidurals placed in surgical inpatients at a single teaching hospital to evaluate the incidence of and potential risk factors for major complications of continuous epidural anesthesia. METHODS: Demographic information, details of the epidural procedure, and complications (from the pre-anesthetic period through resolution) were recorded for more than 5000 surgical inpatients who underwent continuous epidural anesthesia in our institution between March 2009 and April 2011...
August 2014: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/24682078/convulsions-in-2-patients-after-bilateral-ultrasound-guided-transversus-abdominis-plane-blocks-for-cesarean-analgesia
#2
Emmanuel Weiss, Claude Jolly, Jean-Louis Dumoulin, Riadh Ben Meftah, Pierre Blanié, Pierre-Antoine Laloë, Nicolas Tabary, Marc Fischler, Morgan Le Guen
OBJECTIVE: Transversus abdominis plane (TAP) block is commonly used for postcesarean section analgesia and compares favorably with other systemic and regional analgesia techniques. No major complications of ultrasound-guided TAP block have previously been reported in this indication. We report 2 cases of systemic local anesthetic toxicity in this context leading to seizures and treated with lipid emulsion. CASE REPORT: The first event occurred 10 minutes after ultrasound-guided bilateral injections, each consisting of 20 mL of levobupivacaine 3...
May 2014: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/23737258/quality-of-labour-neuraxial-analgesia-and-maternal-satisfaction-at-a-tertiary-care-teaching-hospital-a-prospective-observational-study
#3
Jefferson Clivatti, Naveed Siddiqui, Akash Goel, Melissa Shaw, Ioana Crisan, Jose C A Carvalho
PURPOSE: Current labour analgesia practices are evidence-based; however, such evidence often originates in controlled trials, the results of which may not be readily applicable in the context of day-to-day clinical practice. The objective of this study was to evaluate the effectiveness of and maternal satisfaction with the neuraxial labour analgesia regimen provided at a tertiary care teaching hospital. METHODS: All women with a viable pregnancy who requested neuraxial analgesia for labour during November 2011 at our institution were approached to participate in this prospective study...
August 2013: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/23267002/brief-report-availability-of-lipid-emulsion-in-united-states-obstetric-units
#4
Paloma Toledo, Heather C Nixon, Jill M Mhyre, Cynthia A Wong, Guy Weinberg
BACKGROUND: Lipid emulsion is recommended in the guidelines for the management of local anesthetic systemic toxicity. In this study, we sought to identify the current level of lipid emulsion availability in U.S. obstetric units. METHODS: A survey was developed addressing lipid emulsion availability and sent to U.S. obstetric anesthesia directors in June 2011. Univariate statistics were used. RESULTS: The response rate was 69%. Lipid emulsion was available in 88% of the units (95% confidence interval, 73%-94%)...
February 2013: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/22915878/neurological-adverse-events-following-regional-anesthesia-administration
#5
Christopher D Kent, Laurent Bollag
Regional anesthesia and analgesia have been associated with improved analgesia, decreased postoperative nausea and vomiting, and increased patient satisfaction for many types of surgical procedures. In obstetric anesthesia care, it has also been associated with improved maternal mortality and major morbidity. The majority of neurological adverse events following regional anesthesia administration result in temporary sensory symptoms; long-term or permanent disabling motor and sensory problems are very rare...
2010: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/21494132/local-anesthetic-toxicity-and-lipid-resuscitation-in-pregnancy
#6
REVIEW
Sarah Bern, Guy Weinberg
PURPOSE OF REVIEW: Lipid emulsion has emerged as an effective treatment of local anesthetic-induced cardiac arrest, but its therapeutic application for the obstetric patient requires definition at present. This review discusses clinical reports, relevant laboratory studies, and future directions for the development of an optimal protocol for lipid resuscitation in pregnancy. RECENT FINDINGS: Several mechanisms have been postulated to account for the apparent enhanced sensitivity to local anesthetic systemic toxicity during pregnancy...
June 2011: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/21146952/-epidural-analgesia-is-not-the-only-cause-of-peripartum-central-neurologic-symptoms-report-of-one-case-of-posterior-reversible-encephalopathy-syndrome
#7
B Etesse, V Letouzey, C Roger, A Lefauconnier, J Ripart
A young woman without any significant medical history received an epidural analgesia for labour. She suddenly presented headache, vision loss, nausea and arterial hypertension a few minutes after a 4-ml ropivacaine 0.75% bolus. The catheter was withdrawn and symptoms completely disappeared within 15 minutes. A new epidural catheter was inserted. Thereafter, the patient gave birth to a healthy newborn infant. Half an hour later, while the epidural catheter was still infusing, she presented generalized tonicoclonic seizure...
January 2011: Annales Françaises D'anesthèsie et de Rèanimation
https://www.readbyqxmd.com/read/21112763/the-role-of-lipid-emulsion-during-advanced-cardiac-life-support-for-local-anesthetic-toxicity
#8
REVIEW
P Toledo
Lipid emulsion has recently emerged as a potential antidote for local anesthetic systemic toxicity. This review examines the literature and guidelines for administration of lipid emulsion in the setting of advanced cardiac life support.
January 2011: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/20861424/continuous-subcutaneous-instillation-of-bupivacaine-compared-to-saline-reduces-interleukin-10-and-increases-substance-p-in-surgical-wounds-after-cesarean-delivery
#9
RANDOMIZED CONTROLLED TRIAL
Brendan Carvalho, David J Clark, David C Yeomans, Martin S Angst
BACKGROUND: Recent evidence suggests that locally delivered local anesthetics may exert tissue-damaging effects such as chondrolysis after intraarticular injection. Alteration of the inflammatory response is a potential mechanism for local anesthetic-induced tissue toxicity. In this study, we tested the effects of continuous local anesthetic infiltration on the release of inflammatory and nociceptive mediators in skin wounds after cesarean delivery. METHODS: Thirty-eight healthy women undergoing cesarean delivery with spinal anesthesia were enrolled in this study, and were randomized to receive subcutaneous surgical wound infiltration with bupivacaine 5 mg/mL or saline at 2 mL/h for 24 hours after cesarean delivery...
December 2010: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/20627689/side-effects-of-spiramycin-masquerading-as-local-anesthetic-toxicity-during-labor-epidural-analgesia
#10
B Julliac, H Théophile, M Begorre, B Richez, F Haramburu
Significant fetal bradycardia occurred when a parturient receiving labor epidural analgesia experienced generalized numbness and tingling, a metallic taste and hot flushes. An emergent cesarean delivery under general anesthesia was performed with favorable outcomes for the mother and baby. The most likely source of the maternal symptoms was spiramycin, which was being administered for treatment of toxoplasmosis.
July 2010: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/20560716/biological-rhythms-of-spinal-epidural-labor-analgesia
#11
Waleska Schneider Vieira, Maria Paz Loayza Hidalgo, Iraci da Silva Lucena Torres, Wolnei Caumo
Pain exhibits temporal variations in intensity due to multiple factors, including endogenous neuroendocrine and various external influences that vary over the 24 h. Also, medications can vary in potency and/or toxicity according to the time when they are administered. However, there is no consensus among studies regarding the 24-h pattern of analgesia during labor. Taking into account the time-of-day when labor analgesia is administered, this study aimed to answer two questions: (i) Is there diurnal variation in visual analogue scale (VAS)-rated pain relief and duration of intrathecal analgesia in patients undergoing labor analgesia? (ii) If there is, what is the influence of the duration of labor on the diurnal variation of the level of pain relief and duration of intrathecal analgesia? This prospective cohort included 41 healthy, nulliparous women in the first stage of labor undergoing spinal-epidural (CSE) analgesia using fentanyl combined with bupivacaine...
June 2010: Chronobiology International
https://www.readbyqxmd.com/read/20137366/comparison-of-bupivacaine-ropivacaine-and-levobupivacaine-with-sufentanil-for-patient-controlled-epidural-analgesia-during-labor-a-randomized-clinical-trial
#12
RANDOMIZED CONTROLLED TRIAL
Li-zhong Wang, Xiang-yang Chang, Xia Liu, Xiao-xia Hu, Bei-lei Tang
BACKGROUND: Ropivacaine and levobupivacaine have been introduced into obstetric analgesic practice with the proposed advantages of causing less motor block and toxicity compared with bupivacaine. However, it is still controversial whether both anesthetics are associated with any clinical benefit relative to bupivacaine for labor analgesia. This study aimed to compare the analgesic efficacy, motor block and side effects of bupivacaine, ropivacaine and levobupivacaine at lower concentrations for patient-controlled epidural labor analgesia...
January 20, 2010: Chinese Medical Journal
https://www.readbyqxmd.com/read/19488539/epidural-block-for-cesarean-section-a-comparative-study-between-0-5-racemic-bupivacaine-s50-r50-and-0-5-enantiomeric-excess-bupivacaine-s75-r25-associated-with-sufentanil
#13
RANDOMIZED CONTROLLED TRIAL
Angélica de Fátima de Assunção Braga, José Aristeu F Frias, Franklin Sarmento da Silva Braga, Rosa Inês Costa Pereira, Mayla F Blumer, Marcia F Ferreira
BACKGROUND AND OBJECTIVES: Epidural 0.5% racemic bupivacaine associated with opioids is a technique used in cesarean sections; however, its toxicity has been questioned. 50% Enantiomeric excess bupivacaine has lower cardio- and neurotoxicity. The efficacy of epidural 0.5% racemic bupivacaine and 0.5% enantiomeric excess bupivacaine associated with sufentanil in parturients undergoing cesarean sections was evaluated. METHODS: Fifty gravida at term, undergoing elective cesarean section under epidural block, were divided in two groups according to the local anesthetic used: Group I - 0...
May 2009: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/19216444/efficacy-of-patient-controlled-epidural-analgesia-during-labor-analgesia-a-prospective-randomized-study-using-0-1-bupivacaine-with-fentanyl-2-mg-ml
#14
RANDOMIZED CONTROLLED TRIAL
Mhamed Sami Mebazaa, Issam Tanoubi, Tahar Mestiri, Mohamed Faouzi Gara, Mohamed Salah Ben Ammar
BACKGROUND: Epidural analgesia is the most effective for the control of pain during labor but irregularity of analgesia, toxicity of local anesthetics (LA) and driving block are the major limits of the modalities of maintenance. AIM: The purpose of this work was to assess the effectiveness and adverse effects of adaptations offered with Patient Controlled Epidural Analgesia (PCEA). METHODS: 40 mono-foetal parturients were randomized in two groups: 0...
June 2008: La Tunisie Médicale
https://www.readbyqxmd.com/read/18336489/availability-of-lipid-emulsion-in-obstetric-anaesthesia-in-the-uk-a-national-questionnaire-survey
#15
MULTICENTER STUDY
R M Williamson, J Haines
There is evidence that administration of lipid emulsion improves outcome in cardiovascular collapse secondary to local anaesthetic toxicity. We sent a questionnaire to the lead consultant anaesthetist in every consultant-led labour ward in the UK asking about local guidelines for treatment of cardiac arrest, and whether or nor lipid emulsion was available on the labour ward and included in the guideline. We received replies from 195 (86%) labour wards. One hundred and seven (55%) reported having a guideline for the treatment of cardiovascular collapse secondary to local anaesthetic toxicity...
April 2008: Anaesthesia
https://www.readbyqxmd.com/read/17311640/epidural-ropivacaine-where-are-the-benefits-a-prospective-randomized-double-blind-trial-in-patients-with-retropubic-prostatectomy
#16
RANDOMIZED CONTROLLED TRIAL
F Heid, A Schmidt-Glintzer, T Piepho, J Jage
BACKGROUND: In comparison with bupivacaine, ropivacaine exhibits comparable anaesthetic effects but with less motor impairment and systemic toxicity. However, the analgesic potency may differ. For example, ropivacaine during obstetric epidural analgesia provides an approximately 40% lower analgesic potency than bupivacaine. Equal visual analogue pain scores require significantly higher dosages of ropivacaine, and general statements about a favourable benefit-risk profile relative to that of bupivacaine may therefore have limited clinical impact...
March 2007: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/17242100/a-comparison-of-minimum-local-anesthetic-volumes-and-doses-of-epidural-bupivacaine-0-125-w-v-and-0-25-w-v-for-analgesia-in-labor
#17
RANDOMIZED CONTROLLED TRIAL
Gordon R Lyons, Mitko G Kocarev, Rowan C Wilson, Malachy O Columb
BACKGROUND: In this study we sought to determine and compare the minimum local anesthetic volumes (MLAV) and doses (MLAD) of two concentrations of bupivacaine for epidural pain relief in labor, and to quantify the effect on dose. METHODS: Eighty women were randomized in a double-blind manner to receive a first bolus of either plain bupivacaine 0.125% (w/v) or 0.25% (w/v). The arbitrary starting volume was 15 mL. Subsequent volumes were decided by sequential allocation according to analgesic efficacy...
February 2007: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/16798442/incisional-and-epidural-analgesia-after-caesarean-delivery-a-prospective-placebo-controlled-randomised-clinical-study
#18
RANDOMIZED CONTROLLED TRIAL
P O Ranta, T I Ala-Kokko, J E Kukkonen, P P Ohtonen, T H Raudaskoski, P K Reponen, N Rawal
BACKGROUND: This study evaluated efficacy, safety and patient satisfaction with incisional analgesia with a subfascial catheter compared to epidural analgesia for pain relief following caesarean section. METHODS: Forty patients were randomised after elective caesarean section to receive either intermittent 10-mL boluses of 0.125% levobupivacaine into the epidural space and physiologic saline into the surgical wound or intermittent 10-mL boluses of 0.25% levobupivacaine into the wound and epidural saline with a repeated 10-dose regimen...
July 2006: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/16488138/a-randomised-comparison-of-0-5-bupivacaine-with-a-lidocaine-epinephrine-fentanyl-mixture-for-epidural-top-up-for-emergency-caesarean-section-after-low-dose-epidural-for-labour
#19
RANDOMIZED CONTROLLED TRIAL
J Goring-Morris, I F Russell
BACKGROUND: When extending a fentanyl-containing, low-dose labour epidural for emergency caesarean section it has been shown that there is no difference in time to surgical readiness between plain bupivacaine 0.5% and mixtures of lidocaine/epinephrine or lidocaine/bupivacaine/epinephrine. However, it is not known whether adding fentanyl to the lidocaine/epinephrine mixture would increase speed of onset or improve the efficacy of the mixture when topping up for an emergency caesarean section...
April 2006: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/16471103/levobupivacaine-versus-racemic-bupivacaine-for-extradural-anesthesia-for-cesarean-delivery
#20
RANDOMIZED CONTROLLED TRIAL
Pornswan Ngamprasertwong, Danai Udomtecha, Somrat Charuluxananan, Oraluxana Rodanant, Chaiwat Srihatajati, Sintichai Baogham
BACKGROUND AND OBJECTIVES: Bupivacaine is available as a racemic mixture of dextrobupivacaine and levobupivacaine. Many studies show that dextrobupivacaine has a greater inherent central nervous system and cardiovascular toxicity than levobupivacaine. The aim of the present study was to investigate the clinical efficacy and safety of levobupivacaine compared with racemic bupivacaine for extradural anesthesia. METERIAL AND METHOD: The authors studied 61 patients undergoing elective cesarean delivery who received either 0...
November 2005: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
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