International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2013
The influence of timing on the effectiveness of epidural blood patches in parturients.
Postdural puncture headache is common in parturients following lumbar puncture. If headache is severe and persistent, an epidural blood patch is recommended. In this paper we reviewed the efficacy of epidural blood patches over a 13-year period at two hospitals in Finland with a particular emphasis on its timing. ⋯ Epidural blood patch performed later than 48 h following lumbar puncture or accidental dural puncture is effective in parturients with postdural puncture symptoms. The recurrence rate of symptoms after an initially successful epidural blood patch is high, and therefore patients should be provided with counselling and contact information.
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Int J Obstet Anesth · Nov 2013
Review Case ReportsElective cesarean delivery in a parturient with Klippel-Feil syndrome.
Klippel-Feil syndrome is defined by congenital fusion of two or more cervical vertebrae and can be associated with abnormalities in multiple systems. Management poses challenges to the anesthesiologist, particularly in pregnancy. Cervical spine immobility and instability can make the management of the airway fraught with danger and vertebral column distortion may make neuraxial anesthesia unreliable. ⋯ A combined spinal-epidural technique was used which initially provided satisfactory anesthesia, but ultimately proved inadequate despite use of the epidural component. Satisfactory anesthesia for surgery was eventually achieved with the addition of an intravenous remifentanil infusion. We review previous case reports discussing anesthetic management of parturients with Klippel-Feil syndrome, and describe the challenges encountered and lessons learned from management of this case.
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Int J Obstet Anesth · Nov 2013
ReviewInteractive technology in obstetric anaesthesia and analgesia: exploring seamless solutions to jagged problems.
Perioperative care often involves treating rapid changes in a patient's physiological profile that requires timely intervention by anaesthetists. Interactive technology and closed-loop systems are currently developed in obstetric anaesthesia and analgesia for maintaining parameters during caesarean section and epidural analgesia. ⋯ The components of an interactive system such as the input sensor or device, microprocessor-based control unit and the effector are introduced. Developments in continuous, non-invasive blood pressure monitoring, control algorithms and smart pump technology would help to redefine how technology can assist obstetric anaesthetists to provide better care and improve clinical outcomes for pregnant women.