International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2006
Case ReportsUndiagnosed phaeochromocytoma mimicking severe preeclampsia in a pregnant woman at term.
We report an unusual case of phaeochromocytoma in pregnancy. The patient presented with severe hypertension, visual disturbances, proteinuria, glycosuria and pulmonary oedema at 38 weeks' gestation. The initial diagnosis was severe preeclampsia, but rapid deterioration of the fetus necessitated an emergency caesarean section under general anaesthesia, following which the maternal condition deteriorated rapidly. ⋯ Post mortem examination of the mother revealed a 5.5-cm tumour of the right adrenal gland confirmed histologically as a phaeochromocytoma. We examine the diagnostic dilemmas of this case and consider the treatment and management options when faced with a critically ill mother and the need to deliver her fetus by emergency caesarean section. We also question the clinical priorities during management of a sudden deterioration in both maternal and fetal health.
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Int J Obstet Anesth · Jul 2006
Randomized Controlled TrialA randomised double-blinded controlled trial of the effect of diluent volume on the efficacy of a single dose of epidural ropivacaine for labour analgesia.
Few studies have systematically investigated the effect of diluent volume on the efficacy of epidural local anaesthetics for labour analgesia and no data are available for ropivacaine. Our aim was to compare epidural ropivacaine given in three different volumes for labour analgesia. ⋯ Under the conditions of this study, within the range of 5-20 mL, the volume and concentration were not significant factors influencing the efficacy of a single 30-mg bolus of epidural ropivacaine given for labour analgesia. This suggests that the most important factor influencing analgesic efficacy was drug mass.