International journal of obstetric anesthesia
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Int J Obstet Anesth · Feb 2018
Case ReportsPre-emptive awake airway management under dexmedetomidine sedation in a parturient with spinal muscular atrophy type-2.
Historically, pregnancy in females with spinal muscular atrophy was contraindicated due to the great risk to the parturient, but with improved management and increased survival more patients are becoming pregnant. We describe the management of a pregnant patient with spinal muscular atrophy type-2, who had severe restrictive lung disease, extensive spinal fusion that precluded neuraxial anesthesia, and chronic respiratory failure on nocturnal Bilevel Positive Airway Pressure. Airway management was further complicated by limited mouth opening and cervical spine ankylosis.
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Int J Obstet Anesth · Feb 2018
Case ReportsPulmonary and laryngeal tuberculosis in a 25-weeks' gestation parturient, diagnosed after failed tracheal intubation.
A pregnant woman at 25weeks of gestation was diagnosed with laryngeal tuberculosis following a failed intubation for upper gastrointestinal endoscopy. Laryngeal tuberculosis represents approximately 1% of all cases of tuberculosis in the United States and presents a unique diagnostic challenge, because accompanying laryngeal changes are both varied and nonspecific. This report highlights both the challenges of the pregnant airway and the diagnosis and treatment of laryngeal tuberculosis.
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Int J Obstet Anesth · Feb 2018
Case ReportsProphylactic use of an intra-aortic balloon pump in a high-risk patient with peripartum cardiomyopathy requiring cesarean delivery.
The use of intra-aortic balloon counter-pulsation for circulatory support in pregnant women with cardiac failure is limited to several case reports. Few publications have addressed the use of intra-aortic balloon counter-pulsation during delivery. We report a case using prophylactic intra-aortic balloon counter-pulsation during the management of a cesarean delivery in a patient with peripartum cardiomyopathy. ⋯ The patient was discharged from the hospital on diuretics and beta-blocker treatment after 20days. Heart failure persisted, requiring heart transplantation 25months later. This report highlights the role of a multidisciplinary team approach in the management of delivery in an obstetric patient with peripartum cardiomyopathy.
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Int J Obstet Anesth · Feb 2018
Thrombosis after aortic balloon occlusion during cesarean delivery for abnormally invasive placenta.
Abnormally invasive placenta is a major cause of postpartum hemorrhage and cesarean hysterectomy. An increasing number of obstetricians worldwide employ prophylactic aortic balloon occlusion to manage bleeding during cesarean delivery in these patients. However, the safety of this procedure in pregnant women has not been confirmed. ⋯ Aortic balloon occlusion for the management of bleeding in women with an abnormally invasive placenta may not uncommonly result in thrombosis. Therefore, the risks and benefits of the procedure must be carefully weighed before it is utilized in these patients.