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PubMed1997

[Tramadol chlorhydrate in the management of gyneco-obstetric pain].

An open prospective and longitudinal study was carried out including 102 female patients whose pain was due to gyneco-obstetric surgery. The average age was 31.5 years and the average weight was 67 kg. The tramadol hydrochloride was administered as a single 100 mg dose p.o. or i.m., when moderate to intense pain was present. At the beginning of the trial, 96.1% of the patients presented moderate to very intense pain. At the end of the period of the trial, 74% reported none or mild pain. The analgesia began after an average of 17 minutes i.m. and 28 minutes p.o. The identified adverse effects were: nausea 1%, vomiting 5% and somnolence 8%. In accordance with the obtained results, we conclude that tramadol chlorhydrate is a good alternative for the treatment of moderate-to-severe acute pain of obstetric and gynecological origin.

Adolescent↗
PubMed1989

Effect of interventions on prescribing of antimicrobials for prophylaxis in obstetric and gynecologic surgery.

The effect of interventions on the conformity of physicians with guidelines for the appropriate use of antimicrobial prophylaxis in obstetric and gynecologic surgery is reported. Guidelines on the appropriate use of antimicrobial prophylaxis in common obstetric and gynecologic surgical procedures were developed in late 1986 by the antibiotic subcommittee at a 1100-bed tertiary-care teaching facility. The guidelines were not adopted immediately by the department of obstetrics and gynecology (OB-GYN). An audit of the medical records of women who had received antimicrobial therapy for abdominal and vaginal hysterectomies and emergency cesarean sections during January through March 1987 showed that cefoxitin was used in 68% of the cases instead of the less expensive and equally efficacious cefazolin as recommended in the guidelines. The projected annual cost of this nonconformity was $26,500. After the subcommittee informed the physicians about the guidelines and the audit results, the OB-GYN department adopted the guidelines. A second audit performed one year later showed that cefazolin was used in the recommended manner in 93% of cases; projected annual cost savings were $25,000. Both audits showed that prophylactic treatment was inappropriately prolonged in 6% of cases. Substantial cost savings were realized by minimizing inappropriate antimicrobial drug use through efforts to promote rational and cost-effective therapy.

Adolescent↗
PubMed2005

Gynaecological health care utilization and use of sex hormones--the study of Health in Pomerania.

BACKGROUND: In Germany, there is a lack of population-based data related to the use of gynaecological health care services. The objectives of our analyses utilizing a population-based cross-sectional survey conducted in one geographically defined area [Study of Health in Pomerania (SHIP)] are to assess the prevalences of: (i) attendance of gynaecological outpatient facilities and of (cervical) cancer screening; (ii) gynaecological and breast surgery; (iii) use of oral contraceptives (OC) and menopausal hormone therapy (MHT). METHODS: We analysed socio-demographic factors, reproductive history, gynaecological service utilization, and use of sex hormones in 2186 women aged 20-79 years. We used standard statistics and sex- and age group-specific weighting factors to reflect characteristics of the population of Western Pomerania. RESULTS: Approximately 43% of women reported surgical procedures. Participation in cancer screening at least once was reported by 78% of women (lifetime prevalence). Two-thirds of women stated ever use of OC, 28% (aged >40 years) ever use of MHT. CONCLUSIONS: Women in Western Pomerania reported a high life-time use of both OC and MHT. The use of cervical cancer screening exceeded the national average. Women had an almost 50% risk of undergoing gynaecological, breast or obstetric surgery. The high use of MHT and surgical procedures calls for efforts regarding continuing medical education and health care policy actions.

Adult↗
PubMedDate not supplied

Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia.

BACKGROUND AND OBJECTIVES: Lipophilic opioids, especially fentanyl and sufentanil, are increasingly being administered intrathecally as adjuncts to spinal anesthesia. This review analyzes the efficacy of these opioids for subarachnoid anesthesia. METHODS: Medline search of the literature from 1980 to the present and a survey of recent meeting abstracts are reviewed. RESULTS: A significant number of citations regarding intrathecal lipophilic opioids as adjuncts to spinal anesthesia were found: 59 are cited in this review. Most clinical experience has been in obstetric surgery, but lipophilic spinal opioid administration is being used with greater frequency for other surgical procedures as well. The benefits include reduction of minimal alveolar concentration (MAC) when general anesthesia is combined with spinal anesthesia and enhancement of the quality of spinal anesthesia without prolongation of motor block. Intrathecal fentanyl and sufentanil allow clinicians to use smaller doses of spinal local anesthetic, yet still provide excellent anesthesia for surgical procedures. Furthermore, lipophilic opioid/local anesthetic combination permits more rapid motor recovery; short outpatient procedures are therefore more amenable to spinal anesthesia. Finally, the side-effect profiles of intrathecal lipophilic opioids are now well characterized and appear less troublesome than intrathecal morphine. CONCLUSIONS: The anesthesia-enhancing properties and side-effect profile of lipophilic opioids administered intrathecally suggest significant roles for these agents as adjuncts to spinal anesthesia for obstetric and outpatient procedures.

Adjuvants, Anesthesia↗
PubMed1982

[Structural features of obstetric abnormalities of pregnant, parturient and puerperal women during perinatal period, evaluated from a viewpoint of main component (author's transl)].

With an aim to analyze abnormalities of women with high risk pregnancy, labor and puerperium during perinatal period, main component analysis was carried out for 860 perinatal women, using each of six groups (large items) of 29 kinds of their abnormalities (small items) as variables and the following results were obtained. 1) Three main components were extracted and their cumulative communarity was 61.9 per cent. 2) Each of the main component was evaluated using the large items themselves and correlation between the large items and the small ones. The first main component was considered to be related to disturbance of fetal passage through the birth canal, the second to utero-placental dysfunction and obstetric surgery due to other indications than the disturbance of fetal passage through the birth canal, the third to the complications accidental to pregnancy. 3) Main component scores of the three main components were stratified by physical conditions of the newborn infants by the analyzed perinatal women and the correlation between the both were evaluated. Explanation of the first main component was found to be reasonable from its correlation with birth weight, developmental status, hyperbilirubinemia, Apgar score massive aspiration syndrome of the newborn infants.

Birth Weight↗
PubMed1998

Effects of a refugee-assistance programme on host population in Guinea as measured by obstetric interventions.

BACKGROUND: Since 1990, 500000 people have fled from Liberia and Sierra Leone to Guinea, west Africa, where the government allowed them to settle freely, and provided medical assistance. We assessed whether the host population gained better access to hospital care during 1988-96. METHODS: In Guéckédou prefecture, we used data on major obstetric interventions performed in the district hospital between January, 1988, and August, 1996, and estimated the expected number of births to calculate the rate of major obstetric interventions for the host population. We calculated rates for 1988-90, 1991-93, and 1994-96 for three rural areas with different numbers of refugees. FINDINGS: Rates of major obstetric interventions for the host population increased from 0.03% (95% CI 0-0.09) to 1.06% (0.74-1.38) in the area with high numbers of refugees, from 0.34% (0.22-0.45) to 0.92% (0.74-1.11) in the area with medium numbers, and from 0.07% (0-0.17) to 0.27% (0.08-0.46) in the area with low numbers. The rate ratio over time was 4.35 (2.64-7.15), 1.70 (1.40-2.07), and 1.94 (0.97-3.87) for these areas, respectively. The rates of major obstetric interventions increased significantly more in the area with high numbers of refugees than in the other two areas. INTERPRETATION: In areas with high numbers of refugees, the refugee-assistance programme improved the health system and transport infrastructure. The presence of refugees also led to economic changes and a "refugee-induced demand". The non-directive refugee policy in Guinea made such changes possible and may be a cost-effective alternative to camps.

Adult↗
PubMed1994

Hospital stay due to various hysterectomies, caesarean section and normal delivery in Turku University Central Hospital area from 1983 to 1992.

The optimal length of hospital stay in obstetrics and gynaecology has recently been much debated, as short hospitalisation times being commonly introduced as alternatives to conventional hospitalisations. The hospital stay for major gynaecological and obstetric surgery as well as normal delivery was studied in the hospitals working in area of the Turku University Central Hospital (population approximately 750,000). In the six studied hospitals the mean hospital stay for abdominal and vaginal hysterectomy decreased during the 1980s by one fifth. In 1992, the mean hospitalisation for hysterectomy varied from 7.4 to 8.3 and from 9.0 to 9.1 days, for abdominal and vaginal hysterectomy, respectively, and that of caesarean section from 8.1 to 8.6 days. The number of days in hospital required for normal delivery was 4.4-6.2 days. These figures are similar to the corresponding national average in Finland, but they also show that the discharge in our country occurs some 2 to 3 times later than what has recently been reported, e.g. from the U.S.A. Consequently, we find that there is a need for a prospective trial to find out how rational short hospitalisation is in the field of obstetrics and gynaecology in Finland.

Adult↗
PubMed1976

[Pregnancy and fetal outcome after cessation of oral contraceptives (author's transl)].

In a total of 4149 prenatal patients there were 849 patients who became pregnant following the cessation of the use of oral contraceptives. Results were compared with pregnancies of a similar series of 1000 patients who never had employed contraceptive steroids. Comparison shows a lower incidence of abortion of 5,6% in the oral contraceptive group, compared with 9,2% among the control group. Results show also a lower incidence of toxemia. The incidence of obstetrical surgery was a little higher than in the control group. The incidence of premature birth, perinatal mortality, congenital anomalies, the frequency of twins and of asphyxia neonatorum were similar in both groups. A special group of 107 pregnancies occurring immediatly after cessation of the pill shows no higher risks in pregnancy, during birth or with regard to fetal outcome. An exception is made by the incidence of premature birth that was in this special group 8,8% compared with 5,4% among the control group.

Abnormalities, Drug-Induced↗
PubMed1995

Serosurvey of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection among hospital-based surgeons. Serosurvey Study Group.

BACKGROUND: Because occupational blood contact places health-care workers at risk for infection with bloodborne pathogens, we wanted to estimate the prevalence of infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) among hospital-based surgeons and correlate the results with occupational and nonoccupational risk factors. STUDY DESIGN: All surgeons in training or in practice in general surgery, obstetrics and gynecology, or orthopedics at 21 hospitals in moderate to high AIDS incidence areas were eligible to participate in a voluntary, anonymous serosurvey. Serum samples were tested for HIV antibody, for HCV antibody, and for markers of HBV infection: hepatitis B surface antigen, total antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen. RESULTS: Of 2,887 eligible surgeons, 770 (27 percent) participated in the study. One of 740 surgeons not reporting nonoccupational risk factors was HIV seropositive (0.14 percent, upper limit 95 percent confidence interval [CI] equals 0.64 percent). None of 20 participants reporting nonoccupational HIV risk factors and none of ten not responding to the question on nonoccupational risk factors were HIV positive. Of 129 (17 percent) participants with past or current HBV infection, three (0.4 percent) had chronic HBV infection; all were negative for hepatitis B e antigen. Risk factors for HBV infection included not receiving hepatitis B vaccine (odds ratio [OR] 14.7, 95 percent CI 8.3 to 26.0) and practicing surgery at least ten years (OR 2.2, 95 percent CI 1.3 to 3.8). Seven (0.9 percent) participants had anti-HCV. CONCLUSIONS: Although not necessarily generalizable to all surgeons in moderate to high AIDS incidence areas, these results do not indicate a high rate of previously undetected HIV infection among surgeons who trained or practiced in these areas, or both. Hepatitis B virus posed the highest risk of infection with a bloodborne pathogen, followed by HCV and HIV.

General Surgery↗
PubMed2004

The effects of S+-ketamine and racemic ketamine on uterine blood flow in chronically instrumented pregnant sheep.

UNLABELLED: Ketamine could be a useful maternal analgesic in obstetric surgery, as it might avoid the need for opioid administration and associated side effects in the newborn. Racemic ketamine passes the placental barrier and has oxytocin-like properties but does not seem to affect uterine blood flow (UBF). S(+)-ketamine was recently approved for clinical use, but its effects on UBF have not been evaluated. Therefore, we studied the effects of S(+)-ketamine on maternal and fetal hemodynamic variables. Equianalgesic doses of S(+)-ketamine (10 mg.kg(-1).h(-1)) or racemic ketamine (20 mg.kg(-1).h(-1)) were infused in 12 chronically instrumented pregnant sheep. Maternal and fetal vital signs, blood gases, and UBF were recorded over 120 min. Neither compound affected uterine perfusion or maternal and fetal hemodynamics. Whereas racemic ketamine increased maternal (+19%) and fetal (+11%) PCO(2) significantly, S(+)-ketamine was without effect. However, both compounds significantly decreased maternal (racemic, -0.05; S(+), -0.03) and fetal (racemic, -0.06; S(+), -0.02) pH. The effects of racemic ketamine and S(+)-ketamine on uterine perfusion are similar, and because of its limited effect on hemodynamics and respiration, S(+)-ketamine might therefore be of interest as an analgesic in the obstetric setting. IMPLICATIONS: The effects of S(+)-ketamine on uterine perfusion and maternal/fetal hemodynamics are similar to those of the racemic mixture in chronically instrumented pregnant sheep. A decreased effect of S(+)-ketamine, as compared with the racemic mixture, on maternal and fetal PCO(2) levels was noted.

Acid-Base Equilibrium↗
PubMed1990

[Use of intraspinal narcotics in obstetric anesthesia and analgesia].

The use of intraspinal narcotics has attracted great interest worldwide, particularly in the discipline of obstetric anesthesia. As the advent of spinal and epidural local anesthetics dramatically effected the anesthetic management of labor, delivery and obstetric surgery, likewise spinally administered opioids are emerging as safe and very effective methods of relieving post-cesarean section pain, improving labor and cesarean section analgesia in combination with local anesthetics, and injected alone in the subarachnoid space for the management of labor itself. Though intraspinal narcotic analgesia is associated with a number of side effects, with proper knowledge these adverse reactions are wither preventable or can be greatly reduced. Compared to the benefits of nearly complete pain relief in the intrapartum and postpartum periods, the price paid in terms of these side effects in minimal. The review was based on a computer-assisted search for articles published after 1975.

Analgesia↗
PubMed2001

[Analysis of maternal mortality in the Czech Republic in 1999].

OBJECTIVE: Analysis of maternal mortality in the Czech Republic in 1999. DESIGN: Retrospective statistical and clinical analysis. SETTING: Department of Obstetrics and Gynecology of the 1st Medical School of Charles University and General University Hospital, Prague 2; 2. Institute for Care of Mother and Child, Prague-Podoli. METHODS: We used database of 10 cases of maternal deaths in the Czech Republic during 1999 to analyze their causes, clinical courses especially related to obstetrical surgery, adequacy of provided care, and characteristics of their occurrence. RESULTS: There were total 10 reported maternal deaths in pregnancy, during labor or within 42 days after delivery in the Czech Republic in 1999. During the same period there were 89,471 live births in the Czech Republic, and Pregnancy-related mortality ratio (A + B + C) was 0.11@1000, i.e. 11.2 deaths per 100,000 live births. This is about 0.044@1000 worse than in 1998 (the last table demonstrates the development of maternal mortality during last 9 years). One reported death was unrelated to gestation (category C), therefore adjusted maternal mortality rate (A + B) was 0.10@1000, i.e. 10.1 deaths per 100,000 live births versus 6.63 deaths per 100,000 live births in 1998. Group A (specific risk--direct maternal mortality) contributed to adjusted maternal mortality by 6 maternal deaths and direct maternal mortality was 6.7 per 100,000 live births. Group B (non-specific risk--undirect maternal mortality) contributed by 3 maternal deaths and undirect maternal mortality was 3.3 per 100,000 live births. CONCLUSION: The increase of maternal mortality in 1999 and forensic impact of some cases indicate the necessity to respect established guideline for obstetrics and gynecology. Currently established complex prophylactic measures to prevent development of thrombembolic complications provede, if fully implemented, possibility to minimize these threatening and formerly very frequent situations leading to death. However, there is ongoing danger of hemorrhagic complications related to the DIC, which despite the modern therapy represent the major factor in maternal mortality and morbidity.

Adolescent↗
PubMed1989

[Rheologic and cytologic study of autologous blood collected with Cell Saver 4 during cesarean].

Intra-operative autologous transfusion has been frequently used in vascular and traumatic surgery for about ten years. The technique would be justified in other procedures when intra-operative bleeding is significant and the quality of retrieved blood is satisfactory. We have studied the potential use of intra-operative autologous transfusion during caesarean section of 15 parturients. The quality of autologous blood (at different stages of the procedure) was assessed after being recovered and washed by "Cell Saver 4" (Haemonetics). Blood quality was assessed through 1) measuring the following: erythrocyte deformability with Erythrometer and Hemorheometer; blood and plasma viscosities; ATP, 2.3 DPG and plasma hemoglobin rates; and RBC morphology through SEM; 2) bacterial detection and identification; 3) detection of foetal cells which could create immunological disturbances if reinjected into the mother. The results showed: 1) little variation in RBC deformability properties with ATP and 2.3 DPG rates which, apart from a slight decrease, remained within the normal range; 2) a 20 fold increase in plasma hemoglobin persisting, despite successive washes, in 80% of cases; 3) positive Staphylococcus epidermidis hemoculture clinically irrelevant in the reinjectable bag in 90% of cases; 4) close to 1% foetal cells in the reinjectable bag in 20% of cases; 5) 8% abnormal cells as seen on SEM (Stage I echinocytes) and a slight swelling of the RBCs, which could account for their fragility. These preliminary results show that intraoperative autologous transfusion could be used in obstetrical surgery, provided that certain precautions are taken to minimize the aforesaid drawbacks.

Adult↗
PubMed2004

[Preliminary results from the SFAR-iNSERM inquiry on anaesthesia-related deaths in France: mortality rates have fallen ten-fold over the past two decades].

A National Confidential Inquiry was conducted among death certificators and anaesthetists. A sample of 3700 death certificates from the year 1999 were randomised, after selection of words relating to anaesthesia, surgery, obstetrics, endoscopy, procedural complications, and violent death, with different ratios according to the words and the age; 500 additional certificates relating to deaths in hospital were evaluated to verify the exhaustive nature of the mention of procedures in the certificates. The certificator was sent a simplified form each time the role of the procedure in death could not be excluded (response rate 97%). The anaesthetist was offered a peer review whenever the role of the anaesthetic procedure could not be ruled out (uptake rate 97%). An expert committee analysed the (anonymized) files to determinate the mechanism of the accident and its relationship to anaesthesia. The mortality rates were estimated from the 1996 "Anaesthesia in France" survey. The annual rates of deaths that were totally or partially related to anaesthesia were respectively 7 (CI95%: 2-12) and 47 (31-63) per million. These mortality rates increased with comorbidity, from 4 per million in patients of ASA physical status class 1 to 554 per million in class 4. Similarly, these rates increased with age, from 7 per million in patients less than 45 years old, to 32 in older patients. Most accidents were of ventilatory (38%: airway management: 6%, aspiration pneumonitis: 9%), cardiac (31%: ischaemia: 25%, including anaemia-related), and vascular origin (30%: hemorrhage: 12%, vasodilation by spinal anaesthesia: 6%, anaphylaxis: 3%). The main surgical procedures involved were orthopaedic (50%: hip fracture, haemorrhagic surgery) and digestive (24%: occlusion, peritonitis). INSERM had previously collected data on complications associated with anaesthesia between 1978 and 1982: the annual rates of deaths that were totally or partially related to anaesthesia were respectively 76 and 263 per million. Compared to these previous data, the anaesthesia-related mortality rate fell ten-fold over the last two decades, while the number of anaesthetic procedures at least doubled. In addition, the number of procedures involving old people and patients with poor physical status was multiplied by four. It seems logical to attribute these results to safety and practice guidelines published after the previous inquiry. Progress remains to be made: the present rate of 1/145000 will serve as a basis for systematic analysis of accidents.

Aged↗
PubMed1990

[Urine flow measurement in pregnancy and the puerperium].

To elucidate effects of gestation on micturition, 337 standardised urine flow measurements with weight transducers were performed on 296 women in normal pregnancy (n = 128), under oral or intravenous tocolysis (n = 103), after spontaneous delivery (n = 20) or obstetric surgery (n = 26) as well as on non-pregnant probands (n = 19) with clinically intact urinary tract for comparison. Average micturition frequency was calculated, as well (n = 86). However, only general trends were discernible from mean value calculations because of wide scatter of uroflow parameters: In normal pregnancy, significant increase in flow rate was observed only in the second trimenon. Major opposite effects were recordable from beta-adrenergics (Fenoterol) only in intravenous tocolysis. Micturition frequency was at its highest level towards the end of pregnancy. Post-partum, only flow rates after forceps delivery were worse than those in the non-pregnant control group, on the other hand after spontaneous delivery flow rates were even better than in the controls. Yet, even significant differences stayed within normal range, so that in general severe disadvantages should not be expected from voiding alterations during pregnancy. Uroflow measurements and frequency/volume charts are not required in the care of pregnant women unless conspicuous findings are derived from analyses of micturition habits, types, and frequencies.

Adult↗
PubMed2002

[Analysis of maternal mortality in the Czech Republic in 2000].

OBJECTIVE: Analysis of maternal mortality in the Czech Republic in 2000. DESIGN: Retrospective statistical and clinical analysis. SETTING: Department of Obstetrics and Gynecology of the 1st Medical School of Charles University and General University Hospital, Prague 2, Institute for the Care of Mother and Child, Prague. INTRODUCTION: We present an annual analysis of maternal mortality in the Czech Republic, organized into two parts: 1) international statistical part, and 2) clinical part in Czech only with abbreviated anonymous analysis of individual cases of maternal death. We are aware that follow-up analysis cannot fully express dramatic situations around all cases or reproduce in details all their aspects. We though believe that this form will help to our gynecologists to learn about courses of the deaths, particularly when the frequency of such cases is low and circumstances are unusual. Individual analyses include also conclusions of expert committees or analyses performed by the Czech Medical Chamber. Comments and notes however are not for forensic purposes and are used only for medical ones. METHODS: We used a database of 10 cases of maternal deaths in the Czech Republic in 2000. We analyzed their causes, clinical courses, especially in connection to obstetrical surgery, and adequacy of provided care. RESULTS: There were 10 reported maternal deaths in connection to pregnancy, labor and delivery or within 42 days after delivery in the Czech Republic in 2000. There were 90,910 live-born babies and total, gross maternal mortality (A + B + C) was 0.11 per 1000, i.e. 11 deaths per 100,000 live-born babies. This is only 0.02 per 1000 better than results in 1999 (Table 3 shows data on maternal mortality for last 10 years). In 2000, there was one maternal death unrelated to gestation--category C, therefore maternal mortality in connection to gestation (A + B) was 0.099 per 1000 i.e. 9.9 deaths per 100,000 live-born babies compared to 10.1 deaths in 1999. The causes of deaths were different. Only two women were within group A (specific risk--direct maternal mortality), therefore direct maternal mortality was 2.2 per 100,000 live-born babies. Seven maternal deaths were in the group B (non-specific risk--indirect maternal mortality) and indirect maternal mortality was unusually high, 7.7 per 100,000 live-born babies. It is difficult to judge the difference due to possible error of small numbers. The demographic part of the report has been sent to the Office of Health Statistics and Information and detailed report to the Department of Health Care of the Ministry of Health of the Czech Republic. CONCLUSIONS: Since 1994, when we introduced nationwide organization measures to identify risk groups of pregnant women and use of micro-heparinization among those, we have succeeded to lower the frequency of thrombolism, till then leading cause of maternal deaths, especially in links to operative deliveries and in smaller extent among high-risk women during pregnancy. The decrease of maternal mortality was substantial, by 50%, however only temporary, followed by a partial increase to about 10 maternal deaths per 100,000 live-born babies. This increase was to increased frequency of coagulopathies, HELLP syndrome, and, in 2000, due to non-specific cardiovascular causes and some neurologic complications. The majority of these cases and especially those with non-adequate obstetrical care will be anonymously analyzed together with responsible chiefs of ob/gyn departments during perinatology conference in 2002 and results will be consequently published. Increase of non-specific causes of maternal deaths in 2000, especially of those with cardiovascular complications, indicate a necessity to be careful especially with older parturients, diabetic women, obese women and "dangerous" multiparae, where the possibility of cardiovascular complications might require need concentrated medical diagnosis. Primary attention, though, should be aimed at impaired coagulation of blood. The cases of complications of DIC persistently show insufficient diagnostic and therapeutic measures especially in small facilities with limited laboratory compartments, outdated and wrong therapeutic measures and almost missing potential for consultancy. In spite of this it is particularly necessary to concentrate on prevention among cases with higher risk for DIC. We have concentrated on publications in collaboration with hematologists and anesthesiologists in this field, although some measures are lacking the universal consent, especially some therapeutic means. It is very important to us that chiefs of ob/gyn departments are open for professional discussions, although some situations are prone to forensic evaluation. We believe that our approach of anonymous analyses with two-year delay is sufficient for necessary audit of maternal mortality.

Adult↗
PubMed2005

A comparison of the proseal laryngeal mask airway, the laryngeal tube S and the oesophageal-tracheal combitube during routine surgical procedures.

BACKGROUND AND OBJECTIVE: This study was performed to compare three supraglottic airway devices: the ProSeal laryngeal mask airway (PLMA), the laryngeal tube S (LTS) and the oesophageal-tracheal combitube (OTC) during routine surgical procedures. METHODS: Ninety American Society of Anesthesiologists (ASA) I-III patients scheduled for routine minor obstetric surgery were randomly allocated to the PLMA (n = 30), the LTS (n = 30) or the OTC (n = 30) group, respectively. The overall success rate, insertion time, cuff pressures and resulting airway leak pressures were determined as well as a subjective assessment of handling and the incidence of sore throat, dysphagia and hoarseness were performed. RESULTS: Insertion time until the first adequate ventilation was significantly (P < 0.0001) shorter in the PLMA (median 29 s; 25-75th percentile 25-48 s; range 10-161 s; success rate 100%) and in the LTS group (38 s; 30-44 s; 13-180 s; 100%) compared to the OTC group (75 s; 48-98 s; 35-180 s; 90%). In vivo cuff pressures and airway leak pressures increased with the inflating cuff volume in all devices and were highest in the OTC group. Postoperatively, patients in the PLMA and the LTS group complained significantly less about sore throat (P < 0.001 and 0.05) and dysphagia (P < 0.001 and 0.02) compared to the OTC group, while there was no difference regarding the incidence of hoarseness. Subjective assessment of handling was comparable with the PLMA and the LTS, but inferior with the OTC. CONCLUSIONS: In conclusion, both PLMA and LTS proved to be suitable for routine surgical procedures and proved to be superior to the OTC which cannot be recommended for routine use.

Blood Pressure↗