TEALE FENNING Medical Education    FAQ   Search   Memberlist   Usergroups   Register   Profile   Log in to check your private messages   Log in  mrcog courses for doctors Epidural analgesia          TEALE FENNING Forum Index -> MRCOG Part 2: MCQ & Past Paper questions View previous topic :: View next topic   Author Message EMAK Century Club Joined: 26 Nov 2006 Posts: 572 Posted: Tue Dec 12, 2006 10:17 am    Post subject: Epidural analgesia Please i'd like to confirm: -- Is epidural analgesia contraindicated in the prsense of IUGr?/ there are conflicting ideas , some says safe, others say it can cause hypotension , although less than spinal anasthesia, therefore lead to dcrease uteroplacental perfusion,,,...so can be used or not? -- Also risk of PPH, I think it increase, and that is why they use misopristol to treat uterine atony in the treatment of PPH,,, Is there any opinioun pls? Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 973 Posted: Tue Dec 12, 2006 6:27 pm    Post subject: hi emak, epidurals are not contraindicated in presence of IUGR, they can be safely performed with pre hydration of patients in whom other reasons for hypotension may also exist. this is routine pracatice for most of our anaesthetists. i have not come across epidurals increasing risk of PPH. misoprostol is used as a part of the step ladder for PPH management but not as a sole drug or first line. Nick, what do you say? _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1862 Location: Nottingham Posted: Wed Dec 13, 2006 5:53 pm    Post subject: I agree 100% - well described Raj Back to top Hadia Koomary Joined: 15 Sep 2008 Posts: 57 Posted: Sun Jan 04, 2009 2:05 pm    Post subject: Spinal anaesthesia reduces incidence of perioperative shivering compared with Epi. Anaesth.. can i ask what are the cause of shivering / periop.? I think the statment is not correct. Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 973 Posted: Tue Jan 06, 2009 7:04 pm    Post subject: Hadia Koomary wrote: Spinal anaesthesia reduces incidence of perioperative shivering compared with Epi. Anaesth.. false -- SA reduces threshold for shivering i.e. causes more shivering ref-- Saito T, Sessler DI, Fujita K, Ooi Y, Jeffrey R. Thermoregulatory effects of spinal and epidural anesthesia during cesarean delivery. Reg Anesth Pain Med 1998;23:418–23 De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology. Anesthesiology 2002;96:467–84 Ozaki M, Kurz A, Sessler DI, Lenhardt R, Schroeder M, Moayeri A, Noyes KM, Rotheneder E. Thermoregulatory thresholds during epidural and spinal anesthesia. Anesthesiology 1994;81:282–8 _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 973 Posted: Tue Jan 06, 2009 7:06 pm    Post subject: Hadia Koomary wrote: can i ask what are the cause of shivering / periop.? Hadia, why don't you make a list? If there are any points left myself or Nick will add to it. R _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top Hadia Koomary Joined: 15 Sep 2008 Posts: 57 Posted: Wed Jan 07, 2009 9:33 am    Post subject: thanks for reply. the points that come to my thinking are : drug allergy, from medication or IV fluid hypothermia blood allergy side effect of some aneasthetic drugs or anaesthetic antagonist and SA thank u Back to top Hadia Koomary Joined: 15 Sep 2008 Posts: 57 Posted: Wed Jan 07, 2009 9:41 am    Post subject: Another point : E A cause loss of variability in fetal CTG. Causes of loss of variation : fetal hypoxia [ for any cause] fetal heart disease ....??? what else, can i have some help ?? 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