Nonpharmacologic approaches to relieve pain during labor, when used as a part of hospital pain relief strategies, provide significant benefits to women and their infants without causing additional harm.

This double-blind prospective study was designed to determine the best dose variables for patient-controlled epidural analgesia (PCEA)

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Obstetric hemorrhage is still a significant cause of maternal morbidity and mortality. Prevention, early recognition, and prompt intervention are the keys to minimizing complications. Resuscitation can be inadequate because of under-estimation of blood loss and misleading maternal response. A young woman may maintain a normal blood pressure until sudden and catastrophic decompensation occurs. All members of the obstetric team should know how to manage hemorrhage because timing is of the essence. Good communication with the blood bank ensures timely release of appropriate blood products. A well-coordinated team is one of the most important elements in the care of a compromised fetus. If fetal anoxia is presumed, there is less than 10 minutes to permanent fetal brain damage. Antepartum anesthesia consultation should be encouraged in parturients with medical problems.

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Purpose Ankylosing spondylitis (AS) is a chronic progressive multisystemic disease. Patients with AS present a specific set of anesthesia-related challenges, and the parturient with AS presents particular anesthetic considerations. We report our experience with a parturient with advanced AS and offer a novel explanation for the high incidence of epidural failures in this patient population. Clinical features We present the case of a 36-yr-old primigravida parturient with a very difficult airway and a history of severe AS. The initial treatment plan was to use a continuous epidural for labour analgesia. Despite two successful placements of lumbar epidural catheters, adequate rostral spread of local anesthesia to control her labour pain was never achieved via the epidural route. Thus, continuous spinal anesthesia was used, which provided effective labour analgesia in this patient. Conclusion We hypothesize that this patient's advanced calcified posterior longitudinal ligament caused a physical barrier to rostral spread of local anesthesia solution within her epidural space. This hypothesis is supported by a recent study highlighting the importance of this ligament in allowing adequate distribution of solution within the epidural space. In addition, the successful use of continuous spinal analgesia adds to the growing body of literature supporting the safety and efficacy of intrathecal catheters for labour analgesia in specific situations. RésuméObjectif La spondylarthrite ankylosante (SpA) est une maladie chronique e´volutive affectant plusieurs syste`mes. Les patients souffrant de SpA posent une se´rie de de´fis spe´cifiques lie´s à l'anesthe´sie et les proble`mes d'une parturiente souffrant de SpA ne´cessitent une approche encore plus e´labore´e. Nous de´crivons notre expe´rience avec une parturiente atteinte de SpA avance´e et proposons une nouvelle explication pour l'incidence e´leve´e d'e´checs de la pe´ridurale dans cette population de patientes. Caractéristiques cliniques Nous pre´sentons le cas d'une parturiente de 36 ans, primipare, ayant des ante´ce´dents de SpA se´ve`re et des voies ae´riennes difficiles. Le plan the´rapeutique initial consistait a`utiliser une pe´ridurale continue pour l'analge´sie au cours du travail. Malgre´la mise en place re´ussie de deux cathe´ters pe´riduraux par voie lombaire, une diffusion rostrale approprie´e de l'anesthe´sie locale pour atte´nuer sa douleur n'a jamais e´teó btenue par voie pe´ridurale. En conse´quence, une

Two techniques of injection for epidural anaesthesia for Caesarean sections were studied. Forty-five patients were randomly divided into two groups. Patients in Group I received 20 ml of lidocaine two per cent with epinephrine via the needle at a rate of 5 ml.30 sec-1 after a 3 ml test dose. Patients in Group II received the same dose of the same solution in increments of 5 ml injected through a catheter after a 3 ml test-dose. Each increment was injected in one minute with a delay of two minutes between injections. Top-up doses were given in both groups to obtain a T4 sensory level. There was no difference between the two groups in the quality of sensory block before delivery. However, the quality was significantly better in Group II after delivery (P = 0.02). The incidence of hypotension was 52.2 per cent in Group I and 13.6 per cent in Group II (P = 0.014). There was no significant difference in maternal and umbilical venous lidocaine concentrations. We conclude that injection in fractional doses is a safer and more efficient technique for epidural anaesthesia for Caesarean section.

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