International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2006
Review Case ReportsDoes postdural puncture headache left untreated lead to subdural hematoma? Case report and review of the literature.
The patient was a 39-year-old pregnant woman who was scheduled for cesarean section. Spinal anesthesia was induced using a 26-gauge needle with an atraumatic bevel. Postoperatively, the patient developed cranial subdural hematoma manifesting as severe non-postural headache, associated with right eye tearing, fifth cranial nerve palsy and left hemiparesis. ⋯ Our report reviews the literature on 46 patients who developed a postdural puncture headache complicated by subdural hematoma following spinal or epidural anesthesia. It is possible that postdural puncture headache left untreated may be complicated by the development of subdural hematoma. Patients developing a postdural puncture headache unrelieved by conservative measures, as well as the change from postural to non-postural, require careful follow-up for early diagnosis and management of possible subdural hematoma.
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We have previously reported that measurement of non-invasive blood pressure during caesarean section under spinal anaesthesia fails in over 50% of cases. We felt that errors would be less likely if blood pressure could be measured at the ankle as it is immobile during caesarean section. The purpose of our study was to determine whether blood pressure measurement at the ankle was equivalent to the arm. ⋯ We cannot recommend the use of the ankle to measure blood pressure during caesarean section.
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Int J Obstet Anesth · Jan 2006
Use of an information leaflet to improve general practitioners' knowledge of post dural puncture headache.
The number of women receiving neuraxial anaesthesia for labour and delivery is increasing. Women are also being discharged into the community sooner after delivery. Thus, complications arising from neuraxial anaesthesia may present to general practitioners, so it is of vital importance that they are familiar with and can manage potential problems associated with these anaesthetic techniques. ⋯ By comparing the two sets of answers, we demonstrated that the leaflet has successfully improved knowledge of post dural puncture headache and other potential sequelae of obstetric epidural analgesia among general practitioners.
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Coronary artery disease is rarely detected during labour and the puerperium. We report the case of a 31-year-old primigravida at 38 weeks of gestation with hypercholesterolaemia and a family history of coronary heart disease, who presented with septal acute myocardial infarction. We decided to perform a caesarean section under general anaesthesia. ⋯ There were no complications during or after surgery. Cardiac ultrasound showed septal hypokinesia with normal systolic function and coronary angiography revealed normal coronary vessels. She remained haemodynamically stable and was discharged from intensive care 48 h later.