International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2009
Case ReportsDifficult intubation during rapid sequence induction in a parturient with Ehlers-Danlos syndrome, hypermobility type.
There have been several reports of resistance to local anaesthetic agents in women with Ehlers-Danlos syndrome, hypermobility type, also known as Ehlers-Danlos syndrome Type III. General anaesthesia with rapid sequence induction was performed for caesarean section due to prolonged second stage of labour, but intubation proved to be difficult. ⋯ There are reports of cervical spine instability and temporomandibular joint dysfunction in patients with this syndrome suggesting a potential for difficult airway management. Additional anaesthetic problems associated with Ehlers-Danlos syndrome involve patient positioning and vascular access.
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Int J Obstet Anesth · Oct 2009
Case ReportsAnesthetic management for cesarean delivery in a parturient with exacerbated hemophagocytic syndrome.
Hemophagocytic syndrome is an uncommon disease characterized by cytokine dysfunction and uncontrolled hemophagocytosis. It arises rarely during pregnancy, in which case maternal and fetal mortality are relatively high. It has some similarities with HELLP syndrome. ⋯ General anesthesia was provided successfully for cesarean delivery. The patient recovered completely after this episode. We suggest that early diagnosis, multi-disciplinary intervention, pre-operative correction of the hematological abnormalities, general anesthesia and close postoperative monitoring are necessary.
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Int J Obstet Anesth · Oct 2009
Comparative StudyAn observational study of anaesthesia and surgical time in elective caesarean section: spinal compared with general anaesthesia.
Neuraxial techniques are increasingly used in obstetric anaesthesia. In our hospital, time constraints are the main problem when planning anaesthesia for elective caesarean section. Neuraxial anaesthesia is believed to take longer than general anaesthesia. The objective of this prospective, observational study was to compare time to surgical readiness and total operating room time with spinal with general anaesthesia for elective caesarean section at a Pakistani university hospital for a period of six months. ⋯ In our hospital, the use of spinal anaesthesia was not associated with decreased intra-operative time efficiency compared to general anaesthesia for elective caesarean section.
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Int J Obstet Anesth · Oct 2009
A survey of the management of spinal-induced hypotension for scheduled cesarean delivery.
Intravenous fluids and vasopressors are used for managing spinal-induced hypotension during cesarean delivery, but the choice of vasopressor and the type and timing of fluid administration remain controversial. ⋯ Significant variations in practice exist in the prevention and treatment of spinal-induced hypotension. Fluid preloading and the prophylaxis and treatment of hypotension with ephedrine continue to be common practices.