International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2018
Case ReportsRegional anaesthesia with extracorporeal membrane oxygenation backup for caesarean section in a parturient with neck and mediastinal masses.
Mediastinal mass in pregnancy is a rare condition that presents significant anaesthetic challenges. We present a woman with relapsed Hodgkin's lymphoma during pregnancy who declined to have chemotherapy because of concerns for her unborn child. ⋯ She required delivery of the baby to allow her to receive urgent chemotherapy. We describe successful management of a caesarean section under combined spinal-epidural anaesthesia, at which bilateral femoral vein access was gained in case of the need for urgent extracorporeal membrane oxygenation.
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Int J Obstet Anesth · Aug 2018
Case ReportsBronchoscopic resection of a tracheobronchial leiomyoma in a pregnant patient.
Flexible bronchoscopy, therapeutic bronchoscopy and other procedures requiring anesthesia are generally avoided in pregnancy and postponed until after delivery if possible. We report a case of a parturient with an abnormal chest radiograph and mild obstructive symptoms of unknown etiology. At bronchoscopy, a tumor associated with post-obstructive suppuration was found and excised using electrocautery snare and cryotherapy, for restoration of airway patency. Coordination between pulmonary, obstetric, anesthesia, neonatology and thoracic surgery services was essential in ensuring success and the safety of the mother and fetus.
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Int J Obstet Anesth · Aug 2018
Case ReportsPeripartum anaesthetic management of a patient with Brugada syndrome and myoadenylate deaminase deficiency.
Brugada syndrome is a rare electrophysiological cardiac disease which can result in serious arrhythmias and sudden cardiac death. Peripartum management is centred around avoiding arrhythmogenic drugs, including high doses of sodium channel blocking drugs such as bupivacaine. ⋯ There is evidence that myoadenylate deaminase deficiency can predispose patients to developing malignant hyperthermia when exposed to specific anaesthetic agents. We present a case of a pregnant patient with both Brugada syndrome and myoadenylate deaminase deficiency, in which analgesic and general anaesthetic options for each condition presented potentially conflicting dilemmas for the delivery of intrapartum care.
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Int J Obstet Anesth · Aug 2018
Intraperitoneal chloroprocaine is a useful adjunct to neuraxial block during cesarean delivery: a case series.
Use of intraperitoneal local anesthetic to treat intraoperative pain during cesarean delivery has not been described previously. The aim of this study was to determine if intraperitoneal chloroprocaine may be useful as an adjunct to neuraxial block in reducing the proportion of patients with severe intraoperative pain that requires conversion to general anesthesia. Intraperitoneal chloroprocaine was administered during cesarean delivery as a potential alternative, when the anesthesiologist considered performing a general anesthetic due to severe intraoperative pain. ⋯ Intraperitoneal chloroprocaine may be useful as part of a multimodal approach to managing intraoperative pain during cesarean delivery.