International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2013
Randomized Controlled Trial Comparative StudyA comparison of the haemodynamic effects of lateral and sitting positions during induction of spinal anaesthesia for caesarean section.
Hypotension during spinal anaesthesia occurs commonly in parturients. By influencing spread of local anaesthetic, maternal position may affect the speed of onset of sensory block and thus the haemodynamic effects. The aim of this study was to determine whether inducing spinal anaesthesia for caesarean section using plain bupivacaine in the lateral position would result in less hypotension compared with the sitting position. ⋯ Hypotension occurred less frequently when spinal anaesthesia for caesarean using plain bupivacaine was induced with patients in the lateral compared with the sitting position. Values for the lowest recorded mean arterial pressure were greater but values for the lowest recorded systolic blood pressure were similar for patients in the lateral position group.
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Int J Obstet Anesth · Apr 2013
Case ReportsEpidural injection of hydroxyethyl starch in the management of postdural puncture headache.
Epidural blood patch is the standard treatment for postdural puncture headache when symptomatic therapy is ineffective. We report the cases of two patients who received an epidural injection of hydroxyethyl starch when an epidural blood patch was contraindicated; one due to Streptococcus agalactiae bacteraemia and one due to acute leukaemia. Relief of headache was achieved in both patients with no adverse effects. The use of an epidural hydroxyethyl starch injection may be a suitable alternative for treatment of postdural puncture headache if epidural blood patch is contraindicated.
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Int J Obstet Anesth · Apr 2013
Case ReportsRecurrent psychogenic paresis after dural puncture in a parturient.
We describe the case of a 29-year-old parturient who, after undergoing elective cesarean delivery, displayed symptoms of lower extremity weakness and sensory deficit. Her past medical history was significant for asymptomatic Arnold Chiari Type I malformation and asthma. She had received spinal anesthesia that failed to achieve an adequate surgical level requiring conversion to general anesthesia. ⋯ At 27 weeks of gestation, she had similar lower extremity symptoms after a lumbar puncture, performed to exclude meningitis for severe headache symptoms. Psychogenic paresis is not commonly reported in the medical literature and we found no reports of psychogenic paresis after spinal anesthesia in a parturient or recurrent psychogenic paresis. We review the various risk factors, etiology, neurological signs and symptoms, types, therapy and future management of a patient with recurrent conversion disorder.
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Int J Obstet Anesth · Apr 2013
A qualitative analysis of parturients' perspectives on neuraxial labor analgesia.
The decision to use, or not use, neuraxial analgesia is complex and likely multi-factorial. The objectives of this study were to understand parturients' concerns about neuraxial analgesia, and the reasons for not anticipating the use of neuraxial analgesia using qualitative methodology. ⋯ Many women who anticipate not using neuraxial analgesia may be basing their decision on an inaccurate understanding of the risks of the procedure. Improved patient education and counseling that target specific areas of concern may address these misunderstandings.