International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2011
Case ReportsAnaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.
We describe the anaesthetic management of a patient with Liddle's syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle's syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. ⋯ Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle's syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.
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Int J Obstet Anesth · Apr 2011
Case ReportsThe use of thromboelastography for the peripartum management of a patient with platelet storage pool disorder.
We describe the peripartum management of a 26-year-old primigravida with a platelet storage pool disorder who underwent spontaneous vaginal delivery of twins with epidural analgesia. Postpartum hemorrhage from uterine atony, and cervical and vaginal lacerations were treated successfully with 1-desamino-8D-arginine vasopressin and blood products. The use of thromboelastography in the assessment and management of bleeding risk in the setting of platelet storage pool disorder is described.
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Int J Obstet Anesth · Apr 2011
Case ReportsUrgent cesarean delivery and prolonged ventilatory support in a parturient with Fontan circulation and undiagnosed pseudocholinesterase deficiency.
A parturient with Fontan circulation required general anesthesia for urgent cesarean delivery and subsequent prolonged postoperative ventilation for newly-diagnosed pseudocholinesterase deficiency. Anesthetic management necessitated a thorough understanding of the hemodynamic principles of the Fontan circulation and physiologic adaptations during surgical delivery and recovery in the intensive care unit.
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Int J Obstet Anesth · Apr 2011
Estimation of infant dose and exposure to pethidine and norpethidine via breast milk following patient-controlled epidural pethidine for analgesia post caesarean delivery.
There is no information about the distribution of pethidine into breast milk and/or exposure of the breastfed infant during pethidine patient-controlled epidural analgesia after caesarean delivery. ⋯ The combined absolute infant dose of pethidine and norpethidine received via milk was 1.8% of the neonatal therapeutic dose and the combined relative infant dose was below the 10% recommended safety level. Breastfed infants are at low risk of drug exposure when mothers self-administer epidural pethidine after caesarean delivery.