ABSTRACT
OBJECTIVE: To evaluate maternal analgesia after an episiotomy during delivery. METHODS: The present case-control study compared 2 protocols of post-episiotomy infiltration: period A, 20 mL of lidocaine 10mg/mL; period B, 20 mL of ropivacaine 7.5mg/mL. The primary study endpoint was the visual analog scale (VAS) score at 24 hours after episiotomy; secondary endpoints were the VAS scores during suturing and at 2 and 48 hours, and patient satisfaction at 48 hours. RESULTS: In total, 102 women were included in the study. The median VAS score at 24 hours was significantly lower during the ropivacaine period (3 [1.5-4]) than during the lidocaine period (4 [2-6]; P=0.004). A VAS score below 4 at 24 hours was significantly more frequent with ropivacaine (71% versus 43%; P=0.009). The VAS scores at 2 and 48 hours were also lower in the ropivacaine group (2 hours, 0 [0-1] versus 1 [0-3], P=0.01; and 48 hours, 2 [0-3] versus 3 [2-5], P<0.001). Maternal satisfaction was significantly higher in the ropivacaine group. CONCLUSION: Analgesia and maternal satisfaction were improved during the period when ropivacaine was used as opposed to lidocaine. The effect lasted for up to 48 hours.
Subject(s)
Amides/therapeutic use , Anesthetics, Local/therapeutic use , Episiotomy/methods , Lidocaine/therapeutic use , Adult , Amides/administration & dosage , Analgesia, Obstetrical/methods , Anesthesia, Local/methods , Anesthetics, Local/administration & dosage , Case-Control Studies , Female , Humans , Lidocaine/administration & dosage , Longitudinal Studies , Pain Measurement , Patient Satisfaction , Perineum , Pregnancy , Prospective Studies , Ropivacaine , Single-Blind Method , Time Factors , Young AdultABSTRACT
PURPOSE: Because severe preeclampsia (SP) may be associated with acute pulmonary oedema, fluid responsiveness needs to be accurately predicted. Passive leg raising (PLR) predicts fluid responsiveness. PLR has never been reported during pregnancy. Our first aim was to determine the percentage of SP patients with oliguria increasing their stroke volume after fluid challenge. Our second aim was to assess the accuracy of PLR to predict fluid responsiveness in those patients. METHODS: Patients with SP were prospectively included in the study. In the subgroup developing oliguria, transthoracic echocardiography was performed at baseline, during PLR and after a 500 ml fluid infusion over 15 min. Fluid responders were defined by a 15 % increase of stroke volume index. Five consecutive measurements were averaged for all parameters. RESULTS: Twenty-three (56 %) out of 41 patients with SP developed oliguria, 12 (52 %) out of these 23 responded to fluid challenge. During PLR, an increase of the velocity time integral of subaortic blood flow (ΔVTI) above 12 % predicted the response with a sensitivity and specificity of 75 [95 % confident interval (CI): 0.42-0.95] and 100 % (95 % CI: 0.72-1.00), respectively. An algorithm combining ΔVTI and the baseline value of VTI predicted fluid responsiveness with a sensitivity and specificity of 100 % (95 % CI: 0.74-1.00) and (95 % CI: 0.75-1.00). Urine output and respiratory variations of inferior vena cava diameter did not predict fluid responsiveness. CONCLUSIONS: Only 52 % of oliguric patients were responders. PLR accurately predicts fluid responsiveness in the specific setting of SP. This noninvasive test should be tested in future algorithms for the management of SP.
Subject(s)
Fluid Therapy/adverse effects , Oliguria/complications , Pre-Eclampsia/therapy , Pulmonary Edema/etiology , Stroke Volume/physiology , Adult , Cardiac Output/physiology , Echocardiography , Female , Fluid Therapy/methods , Fluid Therapy/standards , France , Hemodynamics/physiology , Humans , Leg/blood supply , Pre-Eclampsia/physiopathology , Pregnancy , Prognosis , Prospective Studies , Risk Factors , Young AdultABSTRACT
BACKGROUND AND PURPOSE: Basic stroke features are hardly known in sub-Saharan countries, and no data are available in Senegal. METHODS: We performed a retrospective hospital-based study in Dakar, Senegal, to assess risk factors and etiology of stroke. Patients were recruited from January 1, 2003, to July 31, 2004, at the Hôpital Principal, Dakar. Strokes had to be ascertained by computed tomography. RESULTS: A total of 107 patients were studied. Seventy percent of strokes were of ischemic nature. For ischemic strokes, mean age was 64.2 years. Hypertension was the main risk factor, occurring in 68%, and diabetes was encountered in 37.3%. Lacunar strokes and cardioembolism accounted for 20% and 13.3%, respectively. Because of the lack of systematic investigations, two thirds of strokes were of undetermined origin. Mortality within 1 month was 38%. For hemorrhagic strokes, mean age was 51 years and 1 month mortality was 56%. CONCLUSIONS: Hypertension is the main risk factor for both ischemic and hemorrhagic strokes in this hospital-based study.
