International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2017
Anaesthesia for abnormally invasive placenta: a single-institution case series.
Abnormally invasive placenta describes a spectrum of disorders resulting in pathological placental implantation. It is associated with the potential for severe maternal haemorrhage and poor fetal outcome. Increasing numbers of women are at risk owing to the rising incidence of uterine surgery and increasing maternal age. We report data over a five-year period describing anaesthetic management of cases of abnormally invasive placenta in a UK tertiary-referral maternity unit and assess how management has developed. ⋯ Our data illustrate the burden on healthcare resources associated with management of abnormally invasive placenta, underlining the continued need for centralised services for treatment of these complex cases. An integrated multidisciplinary approach to case planning, case management and service provision is key to a successful outcome in these cases.
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Int J Obstet Anesth · May 2017
Neuraxial analgesia in a pregnant woman with Fowler's syndrome and sacral neuromodulation.
We report the anesthetic management of a 16-year-old woman with Fowler's syndrome who became pregnant three years after sacral neuromodulation was initiated for treatment of the condition. Multidisciplinary consensus was to switch off the neurostimulator during pregnancy, and attempt vaginal delivery with a neuraxial block. ⋯ Sacral neuromodulation was restarted uneventfully in the early puerperium and the Fowler's syndrome remains well controlled. The baby continues to develop normally three years after delivery.
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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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Previous studies have suggested an inverse relationship between obesity and development of post-dural puncture headache following spinal anesthesia. However, few have investigated the relationship between obesity and headaches after accidental dural puncture with an epidural needle. This study explored whether obesity has any association with headaches following an accidental dural puncture. ⋯ Patients with a high body mass index do not appear to be protected from experiencing a post-dural puncture headache after an accidental dural puncture during placement of labor epidural analgesia. Additionally, the intensity of post-dural puncture headache does not vary with body mass index.
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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.