International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2010
Case ReportsCardiac arrest due to uterine inversion during caesarean section.
We describe the case of a 20-year-old G3P0 woman who was delivered by caesarean section under general anaesthesia, complicated by uterine inversion secondary to undiagnosed placenta accreta and cardiac arrest requiring cardiopulmonary resuscitation. Uterine inversion is a known complication of placenta accreta and is a rare occurrence at caesarean section. Similar cases have been reported, though cardiac arrest is an uncommon feature. The possible causes and management are discussed.
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Int J Obstet Anesth · Apr 2010
Case ReportsNeuraxial labor analgesia in an obese parturient with influenza A H1N1.
We describe the use of epidural analgesia in a 39-year-old G2P1 parturient presenting at 38(+6) weeks estimated gestation with confirmed influenza A H1N1 and superimposed bilateral pneumonia. Although the patient had an uncomplicated intra- and post-partum course, little is known about the safety of performing neuraxial analgesia or anesthesia in patients with influenza. The prevalence of viremia and possible translocation of blood-borne virus to the central nervous system are discussed.
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Int J Obstet Anesth · Apr 2010
Prospective observational study of serial cardiac output by transthoracic echocardiography in healthy pregnant women undergoing elective caesarean delivery.
An understanding of cardiovascular changes in parturients is crucial for their anaesthetic management, but few studies have examined the effect of posture on cardiac output in the peripartum period. ⋯ Cardiac output showed large variability and was lower than previously reported. Cardiac output decreased with the left lateral 10 degrees head-down position due to a reduction in stroke volume that has not previously been reported. The transthoracic examination was acceptable to all women.
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Int J Obstet Anesth · Apr 2010
The intradural space: the fourth place to go astray during epidural block.
Considerable uncertainty exists regarding accidental injection of local anaesthetic into the 'subdural space' during attempted epidural block. A whole range of clinical findings, from excessively high to failed blocks has been reported although many of these findings appear difficult to explain on the basis of our current knowledge of the anatomy. The existence of another, adjacent space, the intradural space, is postulated. ⋯ A review of electron microscopy studies suggested that a 'secondary' subdural space could be opened up by trauma in the distal layers of the dura. Our findings suggest that injection into this 'intradural' space can occur, resulting in an initially inadequate neuraxial block with limited spread. Further volumes of local anaesthetic can be expected to produce satisfactory block, probably as a result of escape to the epidural space. However, late spread to the subdural or subarachnoid space may occur.