International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2017
Review Meta AnalysisCranial nerve palsy following central neuraxial block in obstetrics - a review of the literature and analysis of 43 case reports.
Cranial nerve palsy is a rarely reported complication of central neuraxial block in obstetrics. The aetiology is diverse and includes both decreased and increased intracranial pressure. ⋯ Intracranial hypotension is the most common aetiology of cranial nerve palsy after central neuraxial block in obstetrics. Neuroimaging is recommended in every case, to exclude other neurological causes. Epidural blood patch was the most utilised treatment for post-dural puncture cranial nerve palsy, but outcomes were variable. The majority of cranial nerve palsies resolved over the subsequent weeks and months.
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Int J Obstet Anesth · May 2017
Case ReportsParaplegia after accidental continuous subdural analgesia.
Almost all reported cases of unintentional subdural block have described a reversible disorder. We report a patient who developed an incomplete mixed sensory and motor neurological deficit after accidental continuous subdural infusion of 0.1% levobupivacaine given to provide postoperative analgesia after cesarean section. Our report shows that accidental continuous subdural injection can cause permanent neurological sequelae. In the event of suspected compressive neural damage, subdural fluid accumulation, although very rare, should be considered.
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Int J Obstet Anesth · May 2017
Case ReportsNeuraxial anesthesia in a patient with anti-N-methyl-D-aspartate receptor encephalitis in pregnancy: management for cesarean delivery and oophorectomy.
We describe the neuraxial anesthetic management of a 28-year-old primigravid patient with severe, treatment-refractory anti-N-methyl-D-aspartate receptor encephalitis undergoing cesarean delivery. The presence of an ovarian teratoma was suspected although not confirmed by imaging. ⋯ A combined spinal-epidural technique was used. Delivery was uneventful, and a right oophorectomy was performed for a visible lesion that was later confirmed to be a mature cystic teratoma.
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Int J Obstet Anesth · May 2017
Neuraxial opioids for post-cesarean delivery analgesia: can hydromorphone replace morphine? A retrospective study.
Cesarean delivery is the most common surgical procedure performed in the USA. We evaluated the postoperative analgesic properties of neuraxial hydromorphone compared to neuraxial morphine for post-cesarean delivery analgesia. ⋯ Hydromorphone is a reasonable alternative to morphine for post-cesarean delivery analgesia. With the dosing used in our study, analgesia from morphine lasted longer than hydromorphone via intrathecal and epidural routes; however, neuraxial hydromorphone remains a reasonable option for long-acting analgesia post cesarean delivery.