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• W1963497757 abstract "To the Editor: Combined spinal-epidural (CSE) analgesia is becoming increasingly used to provide pain relief during labor because of rapid onset and profound analgesia, reduced local anesthetic requirement and motor blockade, and increased maternal satisfaction [1]. However, spinal analgesia delays the use of the epidural catheter and thereby delays the diagnosis of absent or inadequate epidural blockade. Therefore, if fetal distress occurs during this period, the use of the epidural catheter to establish anesthesia for emergency cesarean section may be a matter of concern. Recently, Carrie and Westbrook [2] strongly recommended that any epidural injection during the CSE technique should be preceded by a test dose. In addition, when the CSE technique is used for labor pain relief, we believe that the first test dose should not be delayed until intrathecal analgesia has worn off. A dose of 5-7.5 mg of bupivacaine would induce classic signs of spinal anesthesia including motor blockade in case of accidental intrathecal catheterization [3] and should be small enough to have little if any motor effect by the epidural route. Epinephrine (10-15 micro gram) might be added to detect intravascular injection. Its usefulness during standard epidural analgesia remains controversial because of insufficient sensibility and specificity during painful labor [4]. However, once intrathecal analgesia is established (approximate equals 5-15 min), this test dose might be of better reliability, provided continuous monitoring is used (pulse oximetry for instance). This test dose still carries some limitations: it cannot detect subdural catheter location or delayed intrathecal migration. Moreover, it does not establish that the epidural catheter will function adequately to provide surgical anesthesia [5]. For women at high risk for urgent cesarean section, one should consider more complete dosing of the testing of the epidural catheter earlier so that there is time to replace it if it is not functional. Alternatively, one might chose to avoid the CSE technique entirely in this group. Frederic J. Mercier, MD Herve Bouaziz, MD Dan Benhamou, MD Department d'Anesthesie-Reanimation Hopital Antoine Beclere 92141 Clamart Cedex, France" @default.
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• W1963497757 date "1996-08-01" @default.
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• W1963497757 title "Transition from Intrathecal Analgesia to Epidural Anesthesia for Emergency Cesarean Section Using a Combined Spinal Epidural Technique" @default.
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• W1963497757 doi "https://doi.org/10.1097/00000539-199608000-00045" @default.
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