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PubMed2005

Use of anesthesia induction rooms can increase the number of urgent orthopedic cases completed within 7 hours.

BACKGROUND: Mean turnover times and the time spent in the operating room (OR) can be reduced by concurrent induction of anesthesia. Previous studies of anesthesia induction outside the OR have concentrated either on anesthesia-controlled time or turnover time. The goal of this study was to investigate the impact of an induction room model on the whole surgical process, its phases and delays between the phases, and the number of cases performed during the 7-h working day. METHODS: A prospective analysis of OR times was conducted for 5 weeks with the traditional induction-in-the-OR model followed by 4 weeks with a new model: A team of two nurses and one anesthesiologist was added to one OR to perform parallel anesthesia induction in a separate induction room. The durations of phases of surgical process, number of completed cases between 7:45 am and 3:00 pm, and daily raw utilization of the OR were assessed. Results were compared to those measured before the intervention. RESULTS: The mean nonoperative time was reduced by 45.6%, whereas surgery time remained unchanged. The time savings contributed to the concurrent anesthesia induction and the cut down in delays between the phases. The new model allowed one additional case to be performed during the 7-h working day. CONCLUSIONS: Anesthesia induction outside the OR can increase the number of surgical cases performed during a regular workday.

Anesthesia↗
PubMed2005

Motivation and maternal presence during induction of anesthesia.

BACKGROUND: The authors developed a measure to determine whether maternal motivation to be present during induction (Motivation for Parental Presence during Induction of Anesthesia [MPPIA]) is related to children's anxiety during the induction process. METHODS: Mothers and children (aged 2-12 yr) undergoing outpatient, elective surgery and general anesthesia were enrolled in this study (n = 289 dyads). Items to assess motivation for parental presence during induction were selected by experts in anesthesiology, psychology, and child development; mothers completed the resulting 14-item measure as well as assessments of anxiety and coping style. Children's anxiety and compliance was assessed during induction of anesthesia. Factor analysis was performed, and maternal motivation was then examined against children's anxiety during induction of anesthesia. RESULTS: Factor analysis resulted in four scales with a total variance of 72.3%: MPPIA-Desire, MPPIA-Hesitancy, MPPIA-Anxiety, and MPPIA-Preparation. Analysis supported the reliability (0.89-0.94) and validity of the MPPIA. The authors found that mothers with high MPPIA-Desire and low MPPIA-Hesitancy had children with significantly higher anxiety (P < 0.0001) during induction of anesthesia, as compared with mothers with low MPPIA-Desire and MPPIA-Hesitancy. The authors also found that highly motivated mothers reported significantly higher levels of anxiety (P = 0.007). CONCLUSION: Clinicians should be aware that many mothers who have a high desire to be present in the operating room are very anxious and that their children are likely to exhibit high anxiety levels during induction of anesthesia.

Adult↗
PubMed2000

Labor induction.

Labor induction has become commonplace in modern obstetrics. The increasing rate of labor induction has probably played a role in the increased rate of cesarean delivery observed in the United States during the past few decades. Clearly, the favorability of the cervix has a substantial impact on the potential success of any labor induction. Induction in the setting of an unfavorable cervix can result in prolonged induction, prolonged hospitalization, failed induction, and an increased cesarean delivery rate. In this modern era of healthcare reform and cost containment, the identification of therapeutic strategies to enhance the success and cost-effectiveness of labor induction are of great interest. Ongoing research is needed to advance our knowledge of the mechanisms of parturition and cervical ripening in order to direct interventions for labor induction more effectively.

Cervical Ripening↗
PubMed1986

Detailed analysis and demonstration of differences in the kinetics of induction of class I and class II major histocompatibility complex antigens in rejecting cardiac and kidney allografts in the rat.

In this paper, we analyze in detail donor class I and class II major histocompatibility complex (MHC) antigen induction in heart and kidney allografts in the DA-to-PVG rat strain combination. The immunohistological techniques and quantitative absorption analyses utilize monoclonal antibodies and assay systems specific for donor class I and class II MHC antigens, to enable precise interpretation of the results in terms of the MHC antigens of the graft. Quantitative absorption analyses were performed on homogenates comprising 4-6 allografts pooled at each interval examined (days 1-5 for kidneys, days 3-7 for hearts). In the heart allografts, donor class I antigen induction begins at day 3 after transplantation and proceeds rapidly on the 4th and 5th postoperative days. The maximum level (a 10-fold increase in comparison with normal heart) occurs at day 6, and thereafter the level declines. Donor class II antigen induction in the heart allografts follows a similar pattern. In kidney allografts, it was of particular interest that donor class I induction occurred much more rapidly, being already evident on the first postoperative day, and reaching levels 20-fold greater than normal kidney by day 3. Maximum levels (approximately 30-fold that of normal kidney) of donor class I antigens were reached on days 4 and 5. Donor class II induction, by contrast, developed in kidney grafts with kinetics similar to that seen for class II induction in heart grafts (beginning at day 3 and reaching a maximum of 7-fold over normal kidney at day 5). Immunohistological studies were performed at days 1, 3, 5, and 7 after transplantation. These confirmed the early induction of donor class I antigen in the kidney allografts. In kidney, by the fifth postoperative day, all tubules in the cortex and medulla, and the arteriolar vascular endothelium, were strongly positive for class II antigens. However, the glomerulus, including the glomerular capillary endothelium, remained donor-class-II-negative, except for induction of class II antigens on Bowman's capsule. The endothelium of interstitial capillaries also probably remained class-II-negative. These results have potentially important implications for understanding the development of the rejection response.

Animals↗
PubMed1996

Oral tacrolimus (FK506) induction therapy in pediatric orthotopic liver transplantation.

We have adopted the use of an oral tacrolimus induction protocol in pediatric liver transplantation since the commercial release of tacrolimus in 1994. In this study we analyzed the efficacy of oral tacrolimus induction therapy in 17 consecutive transplants (15 patients) performed between 6/94 and 2/95 and 4 additional patients who were retransplanted between 11/93-5/94 and received compassionate oral tacrolimus induction. Sixteen transplants were treated with oral tacrolimus induction only; 5 transplants, oral tacrolimus + ATGAM/OKT3 induction. The protocol consisted of 0.2 mg/kg of tacrolimus orally on the first postoperative day with a corticosteroid taper. Oral tacrolimus was started at day 1-8 in the 5 patients receiving ATGAM/OKT3 induction. Dosages were adjusted over time to maintain a whole-blood trough level of 12-15 ng/ml at 0-1 month, 10-12 ng/ml at 1-3 months, and 5-10 ng/ml after 3 months. The incidence of acute rejection was 50% (8/16) in children on oral tacrolimus induction alone and 80% (4/5) in the tacrolimus + ATGAM/OKT3 group. Epstein-Barr virus infection occurred in 6 of 19 children (32%), with no child developing lymphoproliferative disorder. No adverse effect on renal function was noted. Serum fasting glucose was stable over time while a trend was noted in decreasing serum cholesterol levels at 6 months. Antihypertensive medication was required in 4 of 19 children (21%) posttransplantation. Corticosteroids were withdrawn in 11% (2/19) of patients. Actuarial 1-year patient and graft survivals were 95% and 86%, respectively. The use of oral tacrolimus induction therapy was associated with excellent survival and a low incidence of complications.

Administration, Oral↗
PubMed1994

Transcranial Doppler ultrasonography with induction of anesthesia for neurosurgery.

Intracranial hypertension can occur with induction of anesthesia; however, the clinical significance of this is unclear. We used transcranial Doppler (TCD) ultrasonography in neurosurgical patients during induction of anesthesia and endotracheal intubation to assess the incidence of high intracranial pressure (ICP) waveforms and to correlate TCD observations with specific anesthetics and anesthetic regimens. The middle cerebral artery was monitored by TCD during induction of anesthesia and endotracheal intubation in 196 patients undergoing elective neurosurgery. Middle cerebral artery blood flow velocity (MCABFV) and physiologic data were observed continuously and recorded at the following times: preinduction, induction, intubation, and postintubation. Induction with thiopental or etomidate decreased MCABFV, intubation increased MCABFV, and postintubation ventilation decreased MCABFV. MCABFV was higher throughout the induction sequence in the 92 patients with tumors. Although there were numerous individual exceptions, changes in mean arterial pressure correlated statistically with changes in MCABFV. No patient had an end-diastolic flow velocity of 0. We reached the following conclusions: (a) TCD is a straightforward modality that can be used to monitor dynamic cerebrovascular events during induction of anesthesia; (b) MCABFV is increased with brain tumors; (c) thiopental and etomidate rapidly decrease and intubation rapidly increases MCABFV; and (d) routine TCD monitoring for high ICP waveforms during anesthetic induction for routine elective neurosurgery appears to be unwarranted.

Adult↗
PubMed2006

Induction of labor using a foley balloon, with and without extra-amniotic saline infusion.

OBJECTIVE: To compare transcervical Foley bulb with and without extra-amniotic saline infusion for induction of labor in patients with an unfavorable cervix. METHODS: Women who presented for induction of labor with Bishop score less than 5 were randomly assigned to receive Foley alone or Foley with extra-amniotic saline infusion for induction of labor. Primary outcome was time from start of induction to vaginal delivery. Secondary outcomes were cesarean delivery rates, incidence of chorioamnionitis, Apgar scores at 1 and 5 minutes, and adverse events. RESULTS: One hundred forty women completed the study. Time from induction to vaginal delivery was 16.58 (+/- 7.55) hours in the extra-amniotic saline infusion group compared with 21.47 (+/- 9.95) hours in the Foley group (P < .01). Chorioamnionitis occurred in 4 of 66 (6.1%) women in the extra-amniotic saline infusion group compared with 12 of 74 (16.2%) women in the Foley group (P = .067). Cesarean delivery rate was 21.2% versus 20.1% in the extra-amniotic saline infusion and Foley groups, respectively (P = 1.0). Median 1-minute and 5-minute Apgar scores were 9 in both groups. Adverse events were rare and unrelated to method of induction. CONCLUSION: Induction of labor by using Foley with extra-amniotic saline infusion results in shorter induction-to-vaginal-delivery time than Foley alone, without affecting cesarean delivery rates. LEVEL OF EVIDENCE: II-I

Adult↗
PubMed2003

Virus-cell interactions in the induction of type 1 interferon by influenza virus in mouse spleen cells.

Inactivated influenza A virus and fixed, virus-infected cells induce type 1 interferon (IFN-alpha/beta) production in murine splenocytes. In this study, we have explored the nature of the virus-spleen cell interaction that leads to IFN-alpha/beta induction and the reason for the poor response to some virus strains. IFN-alpha/beta induction by horse serum-sensitive, but not -resistant, strains of influenza virus was inhibited in the presence of horse serum, indicating that binding of the virus to sialylated cell receptors is a necessary step in the induction process. Furthermore, influenza viruses A/PR/8/34 (H1N1) and A/WS/33 (H1N1), which were poor inducers of IFN-alpha/beta in spleen cells, were shown to have a more active neuraminidase than strains that induced higher IFN levels, and IFN-alpha/beta induction by A/PR/8/34 (H1N1) and A/WS/33 (H1N1) was restored in the presence of a neuraminidase inhibitor. Growth of virus in different cell types altered the level of IFN-alpha/beta induced in spleen cells by particular virus strains, suggesting that the nature of the carbohydrate moieties on the viral glycoproteins may also influence IFN-alpha/beta induction in this system. Consistent with this notion, treatment of egg-grown virus with periodate to oxidize viral carbohydrate greatly reduced its capacity for IFN-alpha/beta induction. Furthermore, induction of IFN-alpha/beta was inhibited in the presence of the saccharides yeast mannan and laminarin. Together these findings indicate: (i) a requirement for interaction of the virus with sialylated receptors on the IFN-producing cell; (ii) an influence of viral carbohydrate on the response; and (iii) possible involvement of a lectin-like receptor on the IFN-producing cell in the induction of IFN-alpha/beta or in regulation of this response.

Animals↗
PubMed1993

Comparative Induction of Nitrate and Nitrite Uptake and Reduction Systems by Ambient Nitrate and Nitrite in Intact Roots of Barley (Hordeum vulgare L.) Seedlings.

The induction by ambient NO3- and NO2- of the NO3- and NO2- uptake and reduction systems in roots of 8-d-old intact barley (Hordeum vulgare L.) seedlings was studied. Seedlings were induced with concentrations of NaNO3 or NaNO2 ranging from 0.25 to 1000 [mu]M. Uptake was determined by measuring the depletion of either NO3- or NO2- from uptake solutions. Enzyme activities were assayed in vitro using cell-free extracts. Uptake and reduction systems for both NO3- and NO2- were induced by either ion. The Km values for NO3- and NO2- uptake induced by NO2- were similar to those for uptake induced by NO3-. Induction of both the uptake and reduction systems was detected well before any NO3- or NO2- was found in the roots. At lower substrate concentrations of both NO3- and NO2- (5-10 [mu]M), the durations of the lag periods preceding induction were similar. Induction of uptake, as a function of concentration, proceeded linearly and similarly for both ions up to about 10 [mu]M. Then, while induction by NO3- continued to increase more slowly, induction by NO2- sharply decreased between 10 and 1000 [mu]M, apparently due to NO2- toxicity. In contrast, induction of NO3- reductase (NR) and NO2- reductase (NiR) by NO2- did not decrease above 10 [mu]M but rather continued to increase up to a substrate concentration of 1000 [mu]M. NO3- was a more effective inducer of NR than was NO2-; however, both ions equally induced NiR. Cycloheximide inhibited the induction of both uptake systems as well as NR and NiR activities whether induced by NO3- or NO2-. The results indicate that in situ NO3- and NO2- induce both uptake and reduction systems, and the accumulation of the substrates per se is not obligatory.

Journal Article↗
PubMed1975

Differential regulation of nitrate reductase induction in roots and shoots of cotton plants.

The induction of nitrate reductase activity in root tips of cotton (Gossypium hirsutum L.) was regulated by several amino acids and by ammonium. Glycine, glutamine, and asparagine strongly inhibited induction of activity by nitrate and also decreased growth of sterile-cultured roots on a nitrate medium. Methionine, serine, and alanine weakly inhibited induction, and 11 other amino acids had little or no effect. Ammonium also decreased induction in root tips, but was most effective only at pH 7 or higher. The optimum conditions for ammonium regulation of induction were identical to those for growth of sterile-cultured roots on ammonium as the sole nitrogen source. Aspartate and glutamate strongly stimulated induction, but several lines of evidence indicated that the mechanism of this response was different from that elicited by the other amino acids. The effects of amino acids on induction appeared to be independent of nitrate uptake.In green shoot tissues, all attempts to demonstrate regulation of induction by amino acids failed. The great difference in observed responses of root and shoot to amino acids suggests that their nitrate reductase activities are regulated differently. Differential regulation of this enzyme is consistent with the responses of root and shoot nitrate reductase activity to nitrate.

Journal Article↗
PubMed2004

The effect of an extended hospital induction on perceived confidence and assessed clinical skills of newly qualified pre-registration house officers.

BACKGROUND: Recent studies raise concerns over the preparedness of newly qualified doctors for the role of the pre-registration house officer (PRHO). This study aimed to assess self-perception of preparedness, objective assessment of core clinical skills and the effect of an extended clinical induction programme prior to commencing full duties. METHODS: A group of 26 newly qualified doctors from 1 district general hospital underwent an extended 5-day, ward-based induction programme. The participants completed questionnaires on their own perceptions of their preparedness for PRHO duties and underwent an objective structured clinical examination (OSCE) of 4 core clinical skills prior to induction, on completion of induction and 1 month into working life. RESULTS: At the outset PRHOs had low perceptions of their own capabilities in all clinical scenarios and skills. Most perceptions improved after induction, although in 2 clinical areas they felt even less confident. One month into post there were significant improvements in all areas. Only 1 PRHO passed all 4 clinical skills assessments at the pre-induction assessment. Seven (26%) failed on 1 or more skills at the post-induction assessment. However, all participants were deemed competent in all skills at the 1-month assessment. CONCLUSION: Newly qualified doctors do not feel prepared for PRHO duties and objectively are not competent in basic clinical skills. An extended induction improves preparedness in some but not all clinical areas and improves performance of objectively assessed clinical skills.

Attitude of Health Personnel↗
PubMed2004

A comparison between single- and double-breath vital capacity inhalation induction with 8% sevoflurane in children.

BACKGROUND: This study was conducted to determine if a double-breath (DB) vital capacity (VC) rapid inhalation induction using immediate high-inspired concentration of sevoflurane is as well tolerated as a single-breath (SB) technique and if it results in a shorter induction time. METHODS: A total of 104 children, ASA I-II, 6 year and above, undergoing elective surgery were randomly assigned to two groups: SB VC inhalation induction or DB VC inhalation induction with 8% sevoflurane in 66% nitrous oxide. The induction time, complications (cough, laryngospasm, breath-hold, movement, salivation) and level of satisfaction were documented. RESULTS: Induction was significantly faster in the DB group (41 +/- 9 s) compared with the SB group (50 +/- 14 s). DB inhalation induction was associated with fewer complications (15.4%) than the SB technique (50%). CONCLUSIONS: Double-breath VC inhalation induction with 8% sevoflurane is as well tolerated as a SB technique and results in a faster onset of anaesthesia.

Anesthesia Recovery Period↗
PubMed1999

Misoprostol for induction of labour at term: a more effective agent than dinoprostone vaginal gel.

OBJECTIVE: To compare the efficacy of vaginal misoprostol and dinoprostone vaginal gel for induction of labour at term. DESIGN: A single-blind randomised comparative trial. SETTING: Induction and labour wards of a UK teaching hospital. PARTICIPANTS: Two hundred and eleven pregnant women at term in whom induction of labour was indicated, and with no contra-indication to the use of prostaglandins for the induction of labour. INTERVENTION: The women were randomly assigned to receive vaginal administration of either misoprostol 50 microg four hourly (to a maximum of four doses) or dinoprostone gel 1 mg six hourly (to a maximum of three doses). MAIN OUTCOME MEASURES: Time from induction to delivery, oxytocin requirement in labour, analgesic requirement, mode of delivery, neonatal outcome. RESULTS: The misoprostol group had a highly significant reduction in median induction-delivery interval compared with the dinoprostone group (14.4 hours vs 22.9 hours; P < 0.00001). In addition, more women delivered after only one dose (77% vs 49%; P < 0.0001, OR 3.51, 95% CI 1.94-6.35), and within 12 and 24 hours. There was a reduced need for oxytocin augmentation in labour (21% vs 47%; P < 0.0001, OR 0.30, 95% CI 0.16-0.54). There was no difference in analgesia requirement in labour, or in mode of delivery. There were no adverse neonatal outcomes associated with the use of misoprostol. Women in the misoprostol group experienced more pain in the interval between induction and being given analgesia in labour, but this did not reach statistical significance. CONCLUSIONS: Misoprostol 50 microg vaginally is a more effective induction agent than 1 mg dinoprostone vaginal gel, with no apparent adverse effects on mode of delivery, or on the fetus. The higher pain scores in the misoprostol group must be balanced against the reduction in time spent having labour induced, and the reduction in need for intravenous oxytocin augmentation. Further randomised studies must continue to exclude the possibility of rare adverse side effects.

Adolescent↗
PubMed2004

Pregnancy outcome in women with heart disease undergoing induction of labour.

OBJECTIVE: To examine the safety and outcome of induction of labour in women with heart disease. DESIGN: Prospective single-centre comparative study. SETTING: Major university-based medical centre. POPULATION/SAMPLE: One hundred and twenty-one pregnant women with heart disease. METHODS: The sample included all women with acquired or congenital heart disease who attended our High-Risk Pregnancy Outpatient Clinic from 1995 to 2001. The files were reviewed for baseline data, cardiac and obstetric history, course of pregnancy and induction of labour and outcome of pregnancy. Findings were compared between women who underwent induction of labour and those who did not. Forty-seven healthy women in whom labour was induced for obstetric reasons served as controls. MAIN OUTCOME MEASURES: Pregnancy outcome. RESULTS: Of the 121 women with heart disease, 47 (39%) underwent induction of labour. There was no difference in the caesarean delivery rate after induction of labour between the women with heart disease (21%) and the healthy controls (19%). Although the women with heart disease had a higher rate of maternal and neonatal complications than controls (17%vs 2%, P= 0.015), within the study group, there was no difference in complication rate between the patients who did and did not undergo induction of labour. CONCLUSION: Induction of labour is a relatively safe procedure in women with cardiac disease. It is not associated with a higher rate of caesarean delivery than in healthy women undergoing induction of labour for obstetric indications, or with more maternal and neonatal complications than in women with a milder form of cardiac disease and spontaneous labour.

Adult↗
PubMed2005

Comparison of digital and ultrasonographic examination of the cervix in predicting time interval from induction to delivery in women with a low Bishop score.

OBJECTIVE: To compare pre-induction ultrasonographic cervical length and Bishop score in predicting time to delivery after labour induction with prostaglandins. DESIGN: Prognostic cohort study. SETTING: Tertiary referral maternity unit in a teaching hospital. POPULATION: Two hundred and sixty-six women with singleton pregnancies at between 34(+0) and 41(+3) weeks of gestation requiring induction of labour with prostaglandins for medical indications. METHODS: A secondary analysis of a trial comparing two prostaglandins. Assessment of the Bishop score and measurement of the cervical length by transvaginal sonography were performed by two operators, blinded to each other's results. We estimated the predictive effects on the outcomes of ultrasonographic cervical length and Bishop score. MAIN OUTCOME MEASURE: Time intervals from induction to delivery and to vaginal delivery. RESULTS: Cervical length and Bishop score were associated with the time interval from induction to delivery, based on univariable analyses. When considered jointly in a multivariable model, only the Bishop score was significantly related to the outcome: The higher the Bishop score, the higher the hazard to delivery [hazard ratio (HR): 1.2, 95% confidence interval (CI): 1.1-1.3], illustrating that once the Bishop score is taken into account, further knowledge of cervical ultrasound length (HR: 0.99, 95% CI: 0.98-1.0) did not add any predictive information. Also, Bishop score was predictive of time interval between induction and vaginal delivery (HR: 1.2, 95% CI: 1.1-1.4) while cervical length had no additional predictive value (HR: 0.99, 95% CI: 0.98-1.0) when both cervical length and Bishop score were introduced in the model. CONCLUSIONS: The Bishop score appears to be a better predictor of the time interval from induction to delivery and to vaginal delivery than cervical length after induction of labour for medical reasons.

Adult↗
PubMed2005

Induction of endogenous pathways by antiepileptics and clinical implications.

The aim of this study was to review modifications of the endogenous pathways (e.g. enzyme elevations, normal body constituent depletion or higher formation/excretion of endogenous metabolites) which could be ascribed to enzyme induction by antiepileptic drugs (AEDs). Information on older (e.g. phenobarbital, phenytoin and carbamazepine) and newer drugs (where information is available) is discussed together with clinical implications. The enzymes involved in the endogenous pathways and induced by the AEDs will not be limited to the hepatic microsomal enzymes; extrahepatic enzymes and/or enzymes present in other subcellular fractions will also be discussed, if pertinent. The induction of endogenous pathways by AEDs has been taken into account in the past, but much less emphasis has been given compared with the extensive literature on induction by AEDs of the metabolism of concomitantly administered drugs, either of the same or of different classes. Not all of the endogenous pathways examined and induced by AEDs appear to result in serious clinical consequences (e.g. induction of hepatic ALP, increased excretion of d-glucaric acid or of 6 beta-hydroxycortisol). In some cases, induction of some pathways (e.g. increase of high-density lipoprotein cholesterol or of conjugated bilirubin) might even be a beneficial side-effect, however enzyme induction is considered rather a detrimental aspect for an AED, as induction is generally a broad and a non-specific phenomenon. The new AEDs have generally less induction potential than the older agents. Yet some (felbamate, topiramate, oxcarbazepine and lamotrigine) have the potential for inducing enzymes, whereas others (levetiracetam, gabapentin and vigabatrin) appear to be completely devoid of enzyme inducing characteristics, at least as far as the enzymes investigated are concerned.

Animals↗
PubMed1999

Induction of labour after 1 previous Caesarean section.

The aim of this study was, after induction of labour in women with a previous Caesarean section, to compare the outcome in women with a history of a previous vaginal delivery with women who had never delivered vaginally. A retrospective analysis was performed over a 2-year period, in a Dublin teaching hospital. One hundred and three women who had had 1 previous lower segment Caesarean section had labour induced. Particular attention was given to delivery outcome, history of a vaginal delivery, cervical effacement at induction, influence of epidural analgesia, indication for induction and incidence of uterine rupture. The repeat Caesarean section rate after induction was 20.4%. Of the 51 women who had never previously delivered vaginally, the repeat section rate was 37.3% compared with only 3.9% of the 52 women who had previously delivered vaginally (p < 0.01). Fourteen women who had never delivered vaginally had an uneffaced cervix at induction and the repeat Caesarean section rate in this group was 64.3%. The commonest indication for induction was a postdates pregnancy. The use of epidural analgesia was greater in women who had never delivered vaginally. There were 2 cases of uterine scar rupture. Induction of labour following Caesarean section is associated with a significantly higher incidence of repeat Caesarean section in women who have not had a previous vaginal delivery. If the cervix is not effaced at induction, the repeat Caesarean section rate is higher than if the cervix has started to efface.

Adult↗
PubMed2006

Decremental ramp atrial extrastimuli pacing protocol for the induction of atrioventricular nodal re-entrant tachycardia and other supraventricular tachycardias.

AIM: The primary aim of this study was to evaluate the utility of decremental ramp atrial extrastimuli pacing protocol (PRTCL) for induction of atrioventricular nodal re-entrant tachycardia (AVNRT), and other supraventricular tachycardias (SVTs), compared to standard (STD) methods. METHODS: The study cohort of 121 patients (age 57.51 +/- 14.02 years) who presented with documented SVTs and/or symptoms of palpitations and dizziness, and underwent invasive electrophysiological evaluation was divided into Group I (AVNRT, n = 42) and Group II (Control, n = 79). The PRTCL involved a train of six atrial extrastimuli, delivered in a decremental ramp fashion. The STD methods included continuous burst and rapid incremental pacing up to atrioventricular (AV) block cycle length, and single and occasionally double atrial extrastimuli. Prolongation in the Atrio-Hisian (Delta-AH) intervals achieved by both methods were compared, as were induction frequencies. RESULTS: In Group I, three categories of responses--(1) induction of AVNRT, (2) induction of echo beats only, and (3) none--were observed in 29 (69%), 11 (26%), and 2 (5%) patients with the PRTCL, when compared with 14 (33%), 16 (38%), and 12 (29%) patients with STD methods in the baseline state without the use of pharmacological agents. The Delta-AH intervals for each of these three categories were larger using PRTCL versus STD methods; 293.3 +/- 95.2 ms versus 192.9 +/- 61.4 ms (P < 0.005), 308.6 +/- 68.5 ms versus 189. 9 +/- 64.9 ms (P < 0.0005), and 203.0 +/- 86.3 ms versus 145.8 +/- 58.9 ms (P = NS), respectively. In Group II, in one patient with dual AV nodal physiology but no clinical tachycardia, the PRTCL induced nonsustained (12 beats) AVNRT. Additionally, in this group, both PRTCL and STD methods induced atrial tachycardia in two patients and orthodromic AV re-entrant tachycardia in one patient. CONCLUSION: Decremental ramp atrial extrastimuli pacing PRTCL demonstrates a superior response for induction of typical AVNRT as compared to STD techniques. Because of easy and reliable induction of AVNRT and echo beats by the PRTCL, we recommend it as a method to increase the likelihood of induction of AVNRT. For induction of other SVTs, the PRTCL and the STD methods are comparable.

Arrhythmias, Cardiac↗