Search

Objective: To determine if nulliparous women intending to have epidural analgesia have a similar labour profile and delivery outcome to women who intend to have their labour managed using alternative forms of pain relief., Materials and Methods: A prospective randomised controlled clinical trial conducted at a tertiary obstetric institution. Nulliparous women intending to deliver vaginally with a term singleton fetus were eligible for recruitment., Results: 1159 women were recruited, of whom 992 were subsequently randomised to receive continuous midwifery support (CMS) or epidural analgesia (EPI) on presentation for delivery. The duration of labour was shorter in the CMS group compared with EPI (10.7 hours (inter quartile (IQ) 7.0,15.2) versus 11.4 hours (IQ 8.2,15.2), p = 0.039). The median duration of the first stage was 8.9 hours (IQ 6,12.5) versus 9.5 hours (IQ 7,12.7) (p = 0.069), and the median duration of the second stage was 1.33 hours (IQ 0.6,2.5) versus 1.48 hours (IQ 0.77,2.6) (p = 0.034). The requirement for oxytocin augmentation in spontaneous labour was 39.8% CMS versus 46.2% EPI (p = 0.129). There was no significant difference in the caesarean section rates. The need for any operative delivery was significantly lower in CMS (43.9% CMS versus 51.5% EPI, p = 0.019)., Conclusions: Nulliparous women have a high usage of epidural analgesia, regardless of their prelabour intentions. In women who do not intend to use epidural analgesia, the temporal delay in insertion compared with those who use epidural analgesia as their primary analgesic modality is associated with a small but statistically significant reduction in overall labour duration and operative delivery rates.

A study was conducted with endangered the razorback sucker (Xyrauchen texanus) to determine if environmental exposure to selenium in flooded bottomland sites affected survival, growth, and egg-hatching success. Adults were stocked at three sites adjacent to the Colorado River near Grand Junction, Colorado, in July 1996: hatchery ponds at Horsethief Canyon State Wildlife Area (referred to here as Horsethief; the reference site), a diked tertiary channel at Adobe Creek, and North Pond at Walter Walker State Wildlife Area (WWSWA). Fish were collected in April 1997 and spawned. After two spawnings adults from the three sites were held at Horsethief for an 86-day selenium depuration period. Selenium concentrations at Horsethief were 1.4-3.0 microg/L in water, 0.8-0.9 microg/g in sediment, 4.5 microg/g in muscle plug, and 6.0 microg/g in eggs; at Adobe Creek, <0.7-4.5 microg/L in water, 1.2-2.5 microg/g in sediment, 16-20 microg/g in zooplankton, 9.6 microg/g in muscle plug, and 40 microg/g in eggs; and at North Pond, 3.2-17 microg/L in water, 16-94 microg/g in sediment, 32-48 microg/g in zooplankton, 14 microg/g in muscle plug, and 55 microg/g in eggs. During the depuration period, when adults from Adobe Creek and North Pond were held at Horsethief, the fish lost 7%-13% of their selenium burden in 59 days and 14%-21% in 86 days. Larvae from North Pond adults had the most deformities, followed by Adobe Creek adults, with the fewest deformities found in the Horsethief adults., (Copyright 2002 Wiley Periodicals, Inc.)

Unlabelled: Levobupivacaine is the isolated S-enantiomer of bupivacaine and may be a favorable alternative to spinal bupivacaine. However, its clinical efficacy relative to bupivacaine and its dose-response characteristics, in spinal anesthesia, must first be known. This double-blinded, randomized, cross-over study was designed to compare the clinical efficacy of hyperbaric levobupivacaine and bupivacaine for spinal anesthesia. Eighteen healthy volunteers were randomized into three equal groups to receive two spinal anesthetics, one with bupivacaine and the other with levobupivacaine, of equal-milligram doses (4, 8, or 12 mg). We assessed blockade quality and duration with pinprick, transcutaneous electrical stimulation, thigh tourniquet, abdominal and quadriceps muscle strength, modified Bromage scale, and time until achievement of discharge criteria. Sensory and motor block were similar between the same doses of levobupivacaine and bupivacaine (P > 0.56 to 0.86). For example, in the 12-mg groups of levobupivacaine versus bupivacaine, mean duration of tolerance to transcutaneous electrical stimulation at T12 was 100 min for both. The duration of motor block at the quadriceps was 71 versus 73 min, and time until achievement of discharge criteria was 164 min for both. Hyperbaric spinal levobupivacaine has equivalent clinical efficacy to racemic bupivacaine for spinal anesthesia in doses from 4 to 12 mg., Implications: Hyperbaric spinal levobupivacaine has equivalent clinical efficacy to hyperbaric spinal bupivacaine over the 4-12-mg ranges.