International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2009
Case ReportsTransversus abdominis plane block for analgesia after caesarean section in a patient with an intracranial lesion.
We present our management of a 24-year-old primigravida with a recently diagnosed low-grade left temporal astroglioma, who was delivered by elective caesarean section. General anaesthesia with supplementary bilateral ultrasound-guided transversus abdominis plane blocks was chosen to reduce the requirements for intra- and postoperative opioids, the risk of postoperative respiratory depression and the potential exacerbation of borderline raised intracranial pressure.
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Int J Obstet Anesth · Jan 2009
Case ReportsAccidental intrathecal sufentanil overdose during combined spinal-epidural analgesia for labor.
A laboring woman was accidentally given 45 microg of sufentanil intrathecally in the course of combined spinal-epidural analgesia. She experienced intense pruritus and transient swallowing difficulty without respiratory depression, but still had incomplete pain relief, with delivery and episiotomy repair requiring additional analgesia. This case highlights the importance of adding local anesthetic to intrathecal opioids to facilitate effective analgesia during the second stage of labor. The contributory systems issues and multiple factors that allowed this error to occur are examined.
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Int J Obstet Anesth · Jan 2009
Case ReportsLow-dose combined spinal-epidural anaesthesia for caesarean section in a patient with Eisenmenger's syndrome.
A 34-year-old woman (G3,P0) with Eisenmenger's syndrome and positive HIV serology presented to hospital at 16 weeks of pregnancy. She was hospitalised at 20 weeks under the care of a multidisciplinary team. At 33 weeks caesarean section was performed under low-dose combined spinal-epidural anaesthesia using a needle-through-needle technique. ⋯ The caesarean section proceeded uneventfully without pain or discomfort. The post-partum period was without major incident. Low-dose combined spinal-epidural techniques combine the advantages of spinal and epidural blockade; the versatility allows its use in a wide range of clinical conditions, combining effective anaesthesia with cardiovascular stability.
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Int J Obstet Anesth · Jan 2009
Case ReportsAnaesthesia for caesarean delivery in a parturient following a recent cerebrovascular event.
Ischaemic cerebrovascular events in pregnancy are uncommon. The anaesthetic management of a pregnant patient within six weeks of an ischaemic cerebrovascular event has not previously been reported. Issues raised include consent and minimising further neurological insult. ⋯ Ten days later she required urgent caesarean delivery, which was performed under general anaesthesia. There was no deterioration in neurological function following surgery and eight days postoperatively she was transferred to a neuro-rehabilitation centre for further care. The idiopathic thrombocytopenic purpura did not respond to medical therapy following delivery and a second anaesthetic was required for splenectomy four weeks later.