International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1997
Anesthesia for combined cesarean section and extra-adrenal pheochromocytoma resection: a case report and literature review.
Pheochromocytoma during pregnancy is unusual, with approximately 250 cases now reported in the literature. The current case describes the anesthetic management of a patient with a large extra-adrenal pheochromocytoma who underwent a combined cesarean section and tumor removal in which perioperative hemodynamic control was difficult despite high-dose a-adrenergic blockade. ⋯ Established criteria exist for the adequacy of alpha- and beta-adrebergic blockade for the management of pheochromocytoma in the non-pregnant patient. We discuss how these criteria apply to pregnant patients with pheochromocytoma, and suggest possible modifications to the criteria.
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Int J Obstet Anesth · Apr 1997
Transient radicular irritation after hyperbaric lidocaine spinal anesthesia in parturients.
Two cases of transient radicular irritation in pregnant patients are presented. Both cases involve the combination of spinal anesthesia employing hyperbaric 5% lidocaine and a small gauge pencilpoint needle as well as the surgery being performed in the lithotomy position. We recommend that until the potential for lidocaine-induced neuroradicular irritation under these circumstances is evaluated prospectively, hyperbaric lidocaine should not be used for cases in which a small gauge spinal needle is employed and the patient is placed in the lithotomy position.
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Int J Obstet Anesth · Apr 1997
Prostaglandin-induced ventricular fibrillation during cesarean section.
A case report is presented of ventricular fibrillation after intramyometrial injection of 1 mg dinoprostone (PGE(2)) during cesarean section performed under general anesthesia. Anesthesiologists should be aware of the potential cardiovascular side-effects of prostaglandins used by the obstetrician.
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A 31-year-old woman gravida 4 para 2 who had received epidural analgesia during labour (duration of catheterization 6.5 h) was readmitted 8 days later with a complaint of flu-like symptoms, severe backache and numbness of her thighs. She had a sensory deficit from T4 to L1 and was unable to stand without support. The severe backache prevented adequate assessment of motor function. ⋯ Culture of the drained pus grew Streptococcus pneumoniae. She made a complete recovery and was discharged home on the tenth day. This case illustrates the problem of diagnosing serious postnatal problems that arise following the now fashionable early discharge from hospital.
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Int J Obstet Anesth · Apr 1997
Transient seizure: a subtle clue to diagnosis of subarachnoid haemorrhage.
A case is described of a 25-year-old primigravida who sustained a transient seizure following the administration of an epidural bolus of local anaesthetic. She had previously complained of a headache, and 3 days after caesarean section, died from subarachnoid haemorrhage. This case report highlights the difficulty in diagnosing subarachnoid haemorrhage in pregnancy and discusses the anaesthetic complications that may arise in the presence of an undiagnosed aneurysmal rupture. In this case the diagnosis was delayed due to absence of neurological signs, but the transient seizure may have been a clue to an earlier diagnosis.