International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2008
Internal carotid artery dissection: an unusual cause of postpartum headache.
We report a case of postpartum headache caused by internal carotid artery dissection in a 36-year-old woman following uneventful epidural analgesia for spontaneous labor and vaginal delivery. Cervicocerebral arterial dissection requires rapid diagnosis and anticoagulation to prevent thrombus formation and to avoid secondary cerebral thromboembolism. Fortunately, our patient suffered ischemic symptoms, but no permanent neurologic deficit. Anesthesiologists should consider carotid artery dissection in the differential diagnosis of postpartum headache.
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Int J Obstet Anesth · Jan 2008
Assessment of knowledge regarding cardiopulmonary resuscitation of pregnant women.
The 2000-2002 triennial UK Report on Confidential Enquiries into Maternal Deaths concluded that over 50% of maternal deaths involved substandard care and that many could have been prevented. Catastrophic events leading to cardio-respiratory arrest may necessitate the resuscitation of pregnant women in various hospital locations. This study was designed to evaluate knowledge about resuscitation of parturients among anesthesiologists, obstetricians and emergency physicians. ⋯ We conclude that knowledge of important basic concepts, including the need for LUD and the potential benefit of early cesarean delivery during cardiac arrest, is inadequate among all three specialties. All three departments should provide ACLS physician training with emphasis on the special considerations for parturients.
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Int J Obstet Anesth · Jan 2008
Case ReportsAnesthetic management of labor in a patient with congenitally corrected transposition of the great arteries.
Laboring patients with congenitally corrected transposition of the great arteries present an interesting challenge to anesthesiologists because of the physiological changes that take place during pregnancy and the stress induced by labor. This paper describes the detailed management of a symptomatic parturient with congenitally corrected transposition of the great arteries. The patient was managed with epidural analgesia instituted early in labor with a continuous low-concentration infusion of local anesthetic and opioid but without an initial bolus. She underwent uneventful forceps-assisted vaginal delivery.
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Int J Obstet Anesth · Jan 2008
Case ReportsManagement of a parturient with thrombocytopenia-absent-radius syndrome undergoing urgent caesarean section.
Thrombocytopenia-absent-radius syndrome is a rare congenital condition characterised by a low platelet count and limb abnormalities. There may be airway difficulties and cardiac disease is frequently associated. ⋯ The major anaesthetic difficulties encountered were severe thrombocytopenia with a platelet count 30x10(9)/L, which precluded regional anaesthesia, and extensive limb abnormalities resulting in difficulty with vascular access and cardiovascular monitoring. Platelet transfusion was required but airway difficulties were not encountered.