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Combined Spinal/Epidural Anesthesia For Complicated Deliveries Is Safe.
2001 MAR 22 - (NewsRx.com & NewsRx.net) -- by Michelle Marble, staff medical writer--Combined spinal and epidural (CSE) anesthesia with low doses of intrathecal bupivacaine is safe and effective for deliveries complicated by severe preeclampsia, researchers in the United States report.
"The purpose of our study was to evaluate the quality of anesthesia for cesarean delivery (CD), analgesia for labor (LA), hemodynarnic changes, and neonatal effects of combined spinal and epidural anesthesia (CSE) with two intrathecal doses of bupivacaine and fentanyl in patients with severe preeclampsia," wrote J. Ramanathan and colleagues at the University of Tennessee. "Of the 85 patients with severe preeclampsia (systolic pressures [SBP][greater than equal to]160 mm Hg or diastolic pressures [DBP][greater than equal to]110 mm Hg, and proteinuria [greater than equal to]100 mg/dL), 46 underwent CD and 39 delivered vaginally."
Ramanathan et al. gave the CD group 7.5 mg of hyperbaric bupivacaine and 25 [micro]g fentanyl intrathecally with hopes of obtaining a T4 sensory block. Those CD patients with block levels less than T4 received an additional 2% lidocaine given epidurally to extend the block.
The LA group received the intrathecal dose of 1.25 mg of plain bupivacaine along with 25 [micro]g of fentanyl. This was followed by an epidural infusion of 0.0625% to 0.125% bupivacaine with 2 to 4 [micro]g of fentanyl/ml at 12 to 15 mL/h.
The researchers found that all but four patients in the CD group had greater than or equal to a T4 block. These four patients received an additional 2% lidocaine epidurally. None of them required conversion to general anesthesia. In the LA group, Ramanathan et al. obtained sensory levels of T10 (range, T6-L2) with adequate analgesia.
The baseline mean arterial pressure (MAP) was 122 [+ or -] 13 mm Hg for patients in the CD group and 117 [+ or -] 12 mm Hg for patients in the LA group. ...
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Source: HighBeam Research, Combined Spinal/Epidural Anesthesia For Complicated Deliveries Is...