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Topic: Epidural anaesthesia

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	Epidural - Spinal Ketamine
		Epidural morphine and ketamine in lidocaine was given to all patients at the end of surgery and every 12 hr for three days for analgesia supplemented with PCA morphine.
		We conclude that epidural ketamine is useful for postoperative pain relief, and the superior dose of epidural ketamine is 0.3 mg.kg-1.
		Epidural ketamine does not appear to be a sufficiently effective alternative to epidural diamorphine for routine use in postoperative pain.
	www.csen.com /anesthesia/ketamine.htm (2263 words)

	Epidural (Site not responding. Last check: 2007-10-10)
		Anaesthesia is the absence of pain sensation in either all or part of the body.
		Epidural anaesthesia in labour is a special form of regional anaesthesia which can be used to numb the area of your chest, abdomen, pelvis and legs.
		In obstetrics, epidural anaesthesia is used to temporarily numb the nerves carrying pain sensation from the womb and birth canal.
	www.fhhs.health.wa.gov.au /anaesthesia/epidural.htm (1526 words)

	Anaesthesia UK : Educational points for nerve injury resulting from a labour epidural
		Studies demonstrate that identification of the epidural space on the first attempt is improved and repeat attempts at needle insertion are decreased with the paramedian approach.
		Epidural analgesia has been demonstrated to be of benefit in some labours because it normalises the levels of catecholamines and the mother’s breathing pattern.
		Supine hypotension may occur when an epidural is in progress, and this is why it is important for the mother to either lay on her side or with one hip ‘wedged’ up on a pillow.
	www.frca.co.uk /article.aspx?articleid=306 (3081 words)

	Epidural - Wikipedia, the free encyclopedia
		The term epidural is often short for epidural anesthesia, a form of regional anesthesia involving injection of drugs through a catheter placed into the epidural space.
		Epidural anaesthesia is performed by a trained anaesthetist with the patient either in the preferred sitting position or lying on the side.
		A common solution for epidural infusion in childbirth or for post-operative analgesia is 0.2 percent ropivicaine and 2 μg/mL of fentanyl.
	en.wikipedia.org /wiki/Epidural (3043 words)

	Is epidural anaesthesia acceptable at total hip arthroplasty? Journal of Bone and Joint Surgery - Find Articles (Site not responding. Last check: 2007-10-10)
		Epidural anaesthesia has been shown to be safe in THA1 and may be used with or without an accompanying general anaesthetic.
		Seventy-five patients had general anaesthesia alone, of whom 29 were men with a mean age of 65.7 years (39 to 85) and 46 were women with a mean age of 63.6 years (21 to 83).
		Ninety-eight patients had general, local and opiate epidural anaesthesia, of whom 46 were men with a mean age of 65.9 years (24 to 84), and 52 were women with a mean age of 64.9 years (30 to 86).
	www.findarticles.com /p/articles/mi_qa3767/is_200411/ai_n9469387 (824 words)

	Epidural hematoma - Wikipedia, the free encyclopedia
		Epidural or extradural hematoma is a buildup of blood occurring between the dura mater (the brain's tough outer membrane) and the skull.
		Epidural hematoma commonly results from a blow to the side of the head and is frequently caused by a fracture that passes through an arterial channel in the bone, most commonly a break in temporal bone interrupting middle meningeal artery, a branch of the external carotid (Shepherd, 2004).
		Epidural bleeds, like subdural and subarachnoid hemorrhages, are extra-axial bleeds, occurring outside of the brain tissue, while intra-axial hemorrhages, including intraparenchymal and intraventricular hemorrhages, occur within it (Wagner, 2004).
	en.wikipedia.org /wiki/Epidural_hematoma (915 words)

	Epidural - anaesthetic injection for pain relief in labour
		For surgery in the pelvic region or legs (such as a hip replacement), epidural anaesthesia is an alternative to having a general anaesthetic.
		The alternative to epidural anaesthesia during surgery is usually a general anaesthetic.
		Epidurals may not be suitable for people who have any neurological problems (problems affecting the nervous system), blood clotting problems, or those who have had back problems.
	hcd2.bupa.co.uk /fact_sheets/mosby_factsheets/epidural.html (1262 words)

	Epidural Anaesthesia (page 1)
		Epidural anaesthesia can be used as sole anaesthetic for procedures involving the lower limbs, pelvis, perineum and lower abdomen.
		Epidural analgesia is indicated in obstetric patients in difficult or high-risk labour, e.g.
		Laterally, the epidural space is bordered by the periosteum of the vertebral pedicles, and the intervertebral foraminae.
	www.nda.ox.ac.uk /wfsa/html/u13/u1311_01.htm (1098 words)

	Epidural anaesthesia
		Epidural anaesthesia is the term used to describe the blocking of nerve routes from the spinal cord with a local anaesthetic or painkilling medication.
		In recent years, epidurals have been used in surgical operations to prevent post-operative pain and to reduce complications such as chest infections and blood clots in the legs.
		Epidural anaesthesia has been used for many years, and is a safe and reliable technique.
	www.netdoctor.co.uk /health_advice/facts/epidural.htm (548 words)

	Caudal Epidural Anaesthesia (page 1)
		Caudal anaesthesia has been used for many years and is the easiest and safest approach to the epidural space.
		Epidural fat, the character of which changes from a loose texture in children to a more fibrous close-meshed texture in adults.
		Dosages for adults are 20-30 ml for a block of the lower abdomen and 15-20 ml for a block of the lower limb and perineum.
	www.nda.ox.ac.uk /wfsa/html/u08/u08_011.htm (813 words)

	Epidural Misadventures: A review of the risk and complications associated with epidural anaesthesia (via CobWeb/3.1 ... (Site not responding. Last check: 2007-10-10)
		This patient had an epidural anaesthetic and it was felt that the sympathectomy could have contributed to the failure at resuscitative efforts.
		Epidural hematoma is a complication which we learn about early in our career and many spend a great deal of time fearing someday they will see one.
		Twenty three of the 46 epidural cases were associated with the use of anticoagulants, 4 were associated with thrombocytopenia and the remaining 19 cases had no risk factors reported.
	www.oyston.com.cob-web.org:8888 /anaes/local/muir.html (1847 words)

	Anaesthesia-AZ- Making Anaesthesia easier- Naropin, Diprivan, EMLA
		When prolonged epidural blocks are used, either through continuous infusion or through repeated bolus administration, the risks of reaching a toxic plasma concentration or inducing local neural injury must be considered.
		The volume of the caudal epidural injection may be adjusted to achieve a different distribution of sensory block, as recommended in standard textbooks.
		During epidural infusion, both PPX and 3-hydroxy-ropivacaine are the major metabolites excreted in the urine.
	www.anaesthesia-az.com /article/509875.aspx (3488 words)

	MJA epidural editorial
		Epidural anaesthesia and analgesia may be a preferable technique in such patients,1 as epidural block can attenuate the neurohumoral stress response to surgery,2 potentially improving postoperative cardiorespiratory function and reducing complications.
		The epidural block was established before the commencement of surgery (epidural anaesthesia) and epidural analgesia was continued for three days after surgery.
		Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial.
	www.westmeadanaesthesia.org /pain/mja_epidural_ediorial.html (853 words)

	Epidural Risks - FROM RONNIE Falcão's MIDWIFE ARCHIVES
		I also personally know of a woman who is paralyzed because of nerve damage caused during an epidural (a hematoma pressing on a nerve), have seen one woman go into spinal shock-intubation and crash section, not to mention the good ole dip in the monitor 10-20 minutes after 30% of the epidurals are administered.
		An epidural may necessitate a C-section by relaxing the pelvic muscles so much that a woman is unable to push properly during labor, the researchers noted in the study, published in the December issue of the journal Obstetrics and Gynecology.
		I have seen very different types/"complications" of epidurals at the 3 major academic centers that I've been at and I think it relates to preloading and how rapidly the levels are brought up which relates to dose and volumes used.
	www.gentlebirth.org /archives/epirisks.html (2782 words)

	All About Epidurals: Articles about Breastfeeding, childbirth, and pregnancy online magazine: The Compleat Mother
		Studies suggest that epidurals interfere with the release of oxytocin(32) which, as well as causing the let-down effect in breastfeeding, encourages bonding between a mother and her young(33).
		Epidural research, much of it conducted by the anaesthetists who administer epidurals, has unfortunately focussed more on the pro's and con's of different drug combinations than on possible serious side-effects(34).
		While an epidural is certainly the most effective form of pain relief available, it is worth considering that ultimate satisfaction with the experience of giving birth may not be related to lack of pain.
	www.compleatmother.com /epidural.htm (2079 words)

	Spinal Anaesthesia and Specific CV Conditions
		Spinal anaesthesia is not contraindicated in patients with coronary artery disease.
		Intraoperatively, spinal anaesthesia alone might be expected to confer an advantage over a combined technique due to the unloading of the heart and the avoidance of negatively inotropic general anaesthetic agents.
		Although the benefits of spinal anaesthesia over general anaesthesia with respect to cardiac morbidity reduction remain unproven, there is no reason to believe that morbidity is increased provided that there is a clear understanding of the haemodynamic effects and of the requirement for appropriate and timely intervention.
	www.manbit.com /oa/c83.htm (1191 words)

	Is epidural anaesthesia safe during childbirth? - Pregnancy/birth - DoctorNDTV
		To answer your questions pointedly, epidural significantly reduces labour pains in about 70% women during labour (it also means that it does not in 30%, and the decrease is not significant in some others).
		The anaesthesia itself may lead to an incorrect placement of the catheter (initially or while topping up) and hence complications due to the drug going to the wrong places which is potentially hazardous.
		The labour is longer with epidural and this sometimes leads to a feeling that it is taking too long and may lead to a caesarean section.
	www.doctorndtv.com /faq/detailfaq.asp?id=4209 (415 words)

	Virtual Anaesthesia Textbook - Regional and Local Anaesthesia
		An overview of regional anaesthesia from the CAS annual meeting.
		Local Anaesthesia for Inguinal and Femoral Hernia Repair is a good article from Update in Anaesthesia.
		Anaesthesia for Ophthalmic Surgery Part 1: Regional Techniques in Update in Anaesthesia is an excellent introduction, with clear illustrations.
	www.virtual-anaesthesia-textbook.com /vat/ra.html (341 words)

	Lesson of the week: Postoperative pressure sores after epidural anaesthesia -- Shah 321 (7266): 941 -- BMJ
		Epidural anaesthesia and analgesia provide a better outcome after major surgery.
		Epidural analgesia produces sensory and motor block, and it restricts a patient's movement.
		Epidural analgesia represents a major advance in the care of patients undergoing major surgery.
	www.bmj.com /cgi/content/full/321/7266/941 (1156 words)

	Epidural anaesthesia and low back pain after delivery: a prospective cohort study -- Macarthur et al. 311 (7016): 1336 ...
		Epidural anaesthesia and low back pain after delivery: a prospective cohort study -- Macarthur et al.
		Epidural anaesthesia and low back pain after delivery: a prospective cohort study
		epidural anaesthesia to be a risk factor for low back pain.
	www.bmj.com /cgi/content/full/311/7016/1336 (3090 words)

	Spinal versus epidural anaesthesia for caesarean section
		Regional anaesthesia (spinal or epidural anaesthesia) for caesarean section is the preferred option when balancing risks and benefits to the mother and her fetus.
		Spinal anaesthesia for caesarean section is thought to be advantageous due to simplicity of technique, rapid administration and onset of anaesthesia, reduced risk of systemic toxicity and increased density of spinal anaesthetic block.
		No difference was found between spinal and epidural techniques with regards to failure rate (RR 0.98, 95% CI 0.23 to 4.24; four studies), need for additional intraoperative analgesia (RR 0.88, 95% CI 0.59 to 1.32; five studies), need for conversion to general anaesthesia intraoperatively, maternal satisfaction, need for postoperative pain relief and neonatal intervention.
	www.cochrane.org /reviews/en/ab003765.html (501 words)

	Epidural
		Conitnuous epidural analgesia with bupivacaine-fentanyl versus patient-controlled analgesia with IV morphine for postoperative pain relief after knee ligament surgery.
		Epidural analgesia with local anesthetics after abdominal surgery: earlier motor recovery with 0.2% ropivacaine then 0.175% bupivacaine.
		Randomized trial of epidural bupivacaine and morphine in prevention of stump and phantom pain in lower-limb amputation.
	www.wisc.edu /trc/projects/pop/Epidural.html (687 words)

	Epidural Analgesia for Childbirth
		The challenge for the anesthetist is to stop or minimize the pain but not the labor, and do so in a manner 'SAFE' to both the baby and mother.
		For the last 25 years or so, epidural analgesia has become the popular method of pain control with 70-80% of patients requesting it.
		Epidural Analgesia During Labor University of Alabama School of Medicine
	sblom.com /epidural (321 words)

	Epidural Sprotte Needle, aka Special Sprotte
		In addition to deflecting the catheter laterally, the “rounded ramp” design is such that the catheter may be advanced or withdrawn (for re-positioning of needle) without fear of damaging the epidural catheter.
		Note that in both distal tip length and size of lateral opening, the 19.5G Epidural Sprotte compares closely to that of a 16G Tuohy needle and thus offers the clinician a familiar accomodation to the anatomical structure of the epidural space while offering a markedly less intrusive needle diameter into the patient.
		Sterile Disposable Tuohy needles for Catheter introduction (Continuous Anaesthesia) as well as single shot application are available in a wide range of sizes.
	www.dynamedical.com /pg2a.html (372 words)

	Recurrent neurological symptoms in a patient following repeat combined spinal and epidural anaesthesia -- Sakura et al. ...
		Epidural infusion of bupivacaine and diamorphine for postoperative analgesia: use on general surgical wards.
		17 Niemi G, Breivik H. Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery: a randomised, double-blind, cross-over study with and without adrenaline.
		Postoperative pain control by epidural analgesia after transabdominal surgery: efficacy and problems encountered in daily routine.
	bja.oxfordjournals.org /cgi/content/full/88/1/141 (1631 words)

	Effect of peri- and postoperative epidural anaesthesia on pain and gastrointestinal function after abdominal ...
		Effect of peri- and postoperative epidural anaesthesia on pain and gastrointestinal function after abdominal hysterectomy -- Jørgensen et al.
		Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery (Cochrane Review).
		Epidural analgesia in colonic surgery: results of a randomized prospective study.
	bja.oxfordjournals.org /cgi/content/full/87/4/577 (3426 words)

	CSE Combined Spinal Epidural Anesthesia
		This much discussed technique combines the low failure-rate and reduced latency period of spinal anaesthesia with the option of prolonging anaesthesia through the peridural catheter as required.
		By eliminating friction during the spinal needle's passage through the Tuohy, the important tactile sensation of dura puncture is unobscured.
		A Sprotte spinal needle is inserted coaxially into an Epidural Special Sprotte or Tuohy and emerges through the lateral opening of the Epidural needle.
	www.dynamedical.com /pg2i.html (236 words)

	Epidural anaesthesia information Diseases Database (Site not responding. Last check: 2007-10-10)
		regional loss of feeling or sensation resulting from injection of an anesthetic into the epidural space of the spinal cord; sensation is lost in the abdominal and genital and pelvic areas; used in childbirth and gynecological surgery.
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	www.diseasesdatabase.com /ddb4345.htm (104 words)

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