Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Case Reports
Anaesthetic management and non-invasive monitoring for caesarean section in a patient with cardiomyopathy.
This paper describes the anaesthetic management of a 29-year-old woman for an elective repeat Caesarean section. A diagnosis of peripartum cardiomyopathy (PPCM) had been made after her first delivery by Caesarean section three years earlier. Although the patient was currently asymptomatic, recent echocardiography demonstrated persistent left ventricular dilatation. The choice of haemodynamic monitors and the clinical significance of PPCM in this situation are discussed.
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Despite considerable information and discussion about the risk of serious complications in patients with systemic mastocytosis undergoing general anaesthesia, little is known specifically about the risk to patients with isolated cutaneous mastocytosis. The experience of 29 general anaesthetics in 12 children with urticaria pigmentosa and three with solitary cutaneous mastocytoma was reviewed. No major complications were encountered and the four minor problems seen were self-limiting. The data from this study do not suggest that patients with urticaria pigmentosa or solitary cutaneous mastocytoma are at increased risk of life-threatening complications under general anaesthesia.
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The perioperative course of 41 patients undergoing 85 endoscopic laser resections of central airway lesions under general anaesthesia was reviewed. The CO2 laser was used in 60 procedures and the Nd:YAG in 25. ⋯ Intravenous anaesthesia was associated with a longer duration of recovery room care and a higher incidence of postoperative respiratory complications (delayed extubation, recovery room re-intubation and ventilation, and post-extubation stridor). Inhalation anaesthesia appeared to simplify the intraoperative management and decrease the incidence, duration and severity of immediate postoperative respiratory complications.
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Chronic headaches are difficult problems to manage effectively. A select group of six patients with headache symptoms (throbbing headaches, located in the frontal or occipital areas; aggravated by ambulation and relieved by recumbency) resembling post-dural puncture headache received epidural blood patches using autologous blood for their chronic headaches. Five of the six patients obtained effective and sustained pain relief. ⋯ The mechanism of action of the blood patch in these patients is unclear. It is possible that the headache may have been caused by a low pressure cerebrospinal fluid state, due to an unknown anatomical or physiological defect of the ventriculo-spinal system. Further studies are needed to evaluate this treatment modality.
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Hypoglycaemia can cause serious problems in anaesthetized patients, due to blockade by anaesthesia of the usual compensatory mechanisms. Gravid women develop hypoglycaemia more readily than non-pregnant patients because they live in a state of "accelerated starvation." Three cases are described of healthy parturients undergoing elective Caesarean section under lumbar epidural analgesia whose post-blockade hypotension was difficult to reverse until their low blood glucose concentrations had been normalized. Further investigations of the role played by blood glucose concentrations in the maintenance of cardiovascular homeostasis in pregnant women are indicated. In the meantime, a preanaesthetic blood glucose determination will facilitate measures to ensure a normal blood glucose level before induction of anaesthesia for Caesarean section.