Obstetric epidural test doses

Anaesthesia - Tập 41 Số 12 - Trang 1240-1250 - 1986
G.D. Prince1, Diana G. McGregor1
1G. Prince, MB, FFARCS. Senior Registrar, D. McGregor. MB, FFARCS, Consultant Anaesthetist. Department of Anaesthesia, Newcastle General Hospital, Newcastle upon Tyne NE4 6BP.

Tóm tắt

SummaryA number of obstetric fatalities related to epidural anaesthesia have been reported recently. In each case catheter or needle misplacement had resulted in a lethal intrathecal or intravascular injection. In this review these cases and a number of other similar but nonfatal reports are examined. In many cases, essential safety checks such as the aspiration test and the test dose had not been performed before the epidural injection, but in others one or both of these tests had been used and had failed to predict the complication. Safety test failures generally occurred because ineffective tests were used or because effective tests were inadequately interpreted. This is not surprising because although textbooks recommend a bewildering variety of test doses, they seldom give precise details as to how they should be conducted. A detailed test dose protocol is recommended, which will safely warn of epidural catheter and needle misplacement in the most effective manner possible. If the protocol is used, accidental subarachnoid and intravascular injections can be reduced to a minimum, but they will still occur. It is emphasised that these complications should not cause fatalities if trained personnel and adequate resuscitation facilities are available.

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Tài liệu tham khảo

Morton AW, 1901, The subarachnoid injection of cocain for operations on all parts of the body, American Medicine, 2, 176

10.1136/bmj.2.2594.733

10.1136/bmj.2.2595.914-a

10.1016/S0002-9610(33)91041-7

10.1093/bja/49.1.11

10.1111/j.1365-2044.1982.tb01315.x

Shnider SM, 1979, Anesthesia for obstetrics., 100

10.1007/BF03007831

10.1111/j.1365-2044.1969.tb02909.x

10.1111/j.1365-2044.1985.tb10664.x

Bromage PR, 1978, Epidural analgesia., 660

Winn D., 1984, How dangerous is the jab?, The Sunday Times, 35

10.1097/00000542-198009000-00020

10.1097/00000542-197910000-00001

Albright GA, 1982, Are long acting local anesthetics cardiotoxic?

Tanz RD, 1984, Comparative cardiotoxicity of bupivacaine and lidocaine in the isolated perfused mammalian heart, Anesthesia and Analgesia, 63, 549

Jong RH, 1982, Cardiovascular effects of convulsant and supracon‐vulsant doses of amide local anesthetics, Anesthesia and Analgesia, 61, 3

10.1097/00000542-198401000-00004

10.1097/00000542-198508000-00003

10.1111/j.1365-2044.1981.tb08714.x

Soni V, 1981, Value and limitations of test dose prior to epidural anesthesia, Regional Anesthesia, 6, 23

Kenepp NB, 1980, Inadvertent intravascular injections during lumbar epidural anesthesia, Anesthesiology, 54, 172

10.1097/00000542-195709000-00008

Gavin R., 1965, Continuous epidural analgesia; an unusual cause of dural perforation during catheterisation of the epidural space, New Zealand Medical Journal, 64, 280

10.1111/j.1365-2044.1982.tb01122.x

10.1111/j.1365-2044.1982.tb01123.x

10.1097/00000542-198304000-00023

10.1093/bja/56.12.1373

Barclay DL, 1968, The influence of inferior vena caval compression on the level of spinal anesthesia, American Journal of Obstetrics and Gynecology, 101, 792, 10.1016/0002-9378(68)90035-5

10.1093/bja/55.4.309

10.1111/j.1365-2044.1985.tb10577.x

10.1213/00000539-198411000-00009

Ostheimer GW, 1984, Manual of obstetric anesthesia., 208

10.1136/bmj.2.5097.654

Caterberg J, 1964, Paraplejias consecutivas a anestesia peridural (estudio clinico y experimental), Revista de la Asociacion Medica Argentina, 78, 1

10.1111/j.1365-2044.1954.tb01922.x

10.1136/jnnp.30.3.195

10.1097/00000542-194909000-00001

10.1213/00000539-195011000-00027

Rosayro AM, 1983, The effect of subarachnoid lidocaine and epinephrine on spinal cord blood flow, Anesthesiology, 59, A208

10.1007/BF03009534

10.1097/00004424-197011000-00004

Greiss FC, 1973, Obstetrics and Gynecology Annual, 55

10.1016/0002-9378(76)90276-3

Greiss FC, 1976, Effects of local anesthetic agents on the uterine vasculature and myometrium, American Journal of obstetrics and Gynecology, 124, 889, 10.1016/S0002-9378(16)33393-2

Ahlquist RP, 1947, Influence of drugs and uterine activity upon uterine blood flow, Federation Proceedings, 6, 305

Greiss FC, 1963, The uterine vascular bed: effect of adrenergic stimulation, Obstetrics and Gynecology, 21, 295

Jouppila R, 1978, Effect of segmental extradural analgesia on placental blood flow during normal labour, British Journal of Anaesthesia, 50, 5637

10.1097/00000542-198102000-00006

Hood DD, 1983, James FM. Maternal and fetal effects of intravenous epinephrine containing solutions in gravid ewes, Anesthesiology, 59, A393

10.1113/jphysiol.1905.sp001093

10.1097/00000542-198155060-00018

10.1111/j.1365-2044.1961.tb13401.x

Crawford JS, 1980, Epidural anaesthesia in obstetrics, 2034

10.1097/00000542-198409000-00019

Dawkins CJM, 1949, Modern practice in anaesthesia., 238

10.1097/00000542-198401000-00002

10.1111/j.1365-2044.1973.tb00495.x

10.1111/j.1365-2044.1980.tb03880.x

10.1111/j.1365-2044.1965.tb02551.x

10.1213/00000539-195603000-00002

10.1093/bja/45.8.907

10.1111/j.1365-2044.1958.tb08036.x

10.1111/j.1365-2044.1985.tb10923.x

10.1097/00000542-198408000-00026

Rawndran R, 1979, Apparent intravascular migration of epidural catheter, Anesthesia and Analgesia, 58, 252

10.1097/00000542-197604000-00013

Crawford JS, 1982, Current reviews in obstetrics and gynaecology: obstetric analgesia and anaesthesia., 70

10.1111/j.1365-2044.1986.tb12818.x

10.1111/j.1365-2044.1985.tb10916.x

10.1111/j.1365-2044.1956.tb07999.x

10.1093/bja/29.11.512

10.1097/00000542-198601000-00022

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Anaesthesia

Tập 41 Số 12

1240-1250

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