PubMed · 6823026
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F J Spielman, C B Watson. 1983-02-11. Spinal anesthesia.. https://pubmed.ncbi.nlm.nih.gov/6823026/
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PURPOSE: To assess the safety and efficacy of 37.5 mg ephedrine i.m. in preventing hypotension associated with spinal anaesthesia for Caesarean section. METHODS: In a double-blind randomised controlled study, 40 patients (20 in each group) were given either 37.5 mg ephedrine or placebo i.m. The following parameters were recorded: (i) blood pressure; (ii) heart rate; (iii) ephedrine i.v. supplementation; (iv) umbilical venous blood gases and neonatal Apgar scores. RESULTS: The incidence of hypertension in the study group was 30% compared with 20% for the control group (P:NS). There was no difference in mean highest blood pressure or mean highest heart rate between the groups. The incidence of hypotension was lower but not significantly lower in the study group (50%) than in the control group (80%) (P:NS). However, the incidence of delayed hypotension was only 10% in the study group patients compared with 50% in the control group patients (P < 0.05). CONCLUSION: Giving 37.5 mg ephedrine i.m. prior to spinal anaesthesia was not associated with reactive hypertension or tachycardia. Intramuscular ephedrine provided more sustained cardiovascular support than intravenous ephedrine.
In 1847 J.Y. Simpson in Scotland was the first to describe the administration of ether for analgesia in painful deliveries. Only a few days later E.C.J. von Siebold (1801 in Würzburg-1861 in Göttingen) performed the first systematic study on ether in obstetrics. Following a preceding evaluation of the action of ether on non-pregnant woman and on pregnant women not in active labour, he administered ether for analgesia during the second stage of labour in eight parturients. The first administration was on February 25th 1847. While he was satisfied with the good analgesia without sequelae of the new-born, he was discouraged by the termination of uterine contractions observed in all his patients. He concluded that ether was not a useful substance for analgesia during vaginal delivery, since it disturbed the natural course of labour. On the other hand, von Siebold was very pleased with the administration of ether for operative obstetric procedures such as forceps deliveries or placental retention.
We evaluated a new method of assessing sensory block after spinal anaesthesia using a fine gas jet and compared it with other established methods. The gas jet method was used to test the block before and after surgery and was found to compare favourably with pin-prick (median difference 0 and 0 dermatomes) and ethyl chloride (median difference 0.5 and 1.0 dermatomes) but less well with cotton wool (median difference -2.0 and -2.0 dermatomes).