International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2011
Case ReportsAnaesthesia for caesarean section in a patient with Sturge-Weber syndrome following acute neurological deterioration.
Sturge-Weber syndrome consists of facial capillary malformation (port-wine stain) and abnormal blood vessels in the brain or eye. Seizures, developmental delay and intracranial and airway angiomata are principal concerns. We report a 28-year-old primiparous woman at 41 weeks of gestation with Sturge-Weber syndrome who developed unilateral weakness, aphasia, blurred vision and confusion. ⋯ Despite the possibility of raised intracranial pressure and precipitation of cerebral herniation, a lumbar epidural block was administered but failed. A subarachnoid block was successfully performed and a healthy infant delivered. The choice of anaesthesia was strongly influenced by detailed radiological investigations and multidisciplinary participation.
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Int J Obstet Anesth · Jul 2011
Use of thromboelastography to guide thromboprophylaxis after caesarean section.
Thromboprophylaxis is commonly required following caesarean section. However the effect of thromboprophylactic dosages of subcutaneous heparin on coagulation is unknown because conventional laboratory tests are largely unaffected. The aim of this study was to determine if thromboelastography could detect and quantify the effect of unfractionated heparin on coagulation profile when given at the time of surgery. ⋯ Thromboelastography was able to detect and quantify the effect of unfractionated heparin on blood coagulability, an effect not detected by conventional laboratory tests. Thromboelastography demonstrated a pro-coagulant effect of surgery that was only partially mitigated by the use of unfractionated heparin. In this study, at a dose of 7500 IU subcutaneous unfractionated heparin appears to have little anticoagulant effect.