International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2011
Case ReportsTopical vasoconstrictor use for nasal intubation during pregnancy complicated by cardiomyopathy and preeclampsia.
Ankylosing spondylitis presents challenges for the obstetric anesthesiologist in administering neuraxial anesthesia or managing the airway. A pregnant patient with ankylosing spondylitis, cardiomyopathy and preeclampsia requiring cesarean delivery was managed with an awake nasotracheal fiberoptic intubation. The use of topical cocaine, epinephrine, phenylephrine, and oxymetazoline to produce nasal vasoconstriction is discussed. Selective alpha-2 agonists that can potentially provide nasal mucosa vasoconstriction and placental vasculature vasodilation are also discussed.
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Int J Obstet Anesth · Jul 2011
Case ReportsLower extremity radicular pain after prophylactic intrathecal saline injection through a subarachnoid catheter following accidental dural puncture.
We describe a case in which severe lower extremity radicular pain occurred after administration of 0.9% saline into the subarachnoid space through a catheter that had been left for 20 h following inadvertent dural puncture in an obstetric patient. A 42-year-old (G8P7) woman was admitted for repeat cesarean delivery. Accidental dural puncture occurred during epidural placement. ⋯ Subsequently, the patient developed a postdural puncture headache that persisted for three days. The patient's radiculitis and paresthesia likely resulted from an acute increase in intrathecal pressure after saline administration or from direct catheter irritation. Although both intrathecal saline administration and subarachnoid catheter placement have been previously proposed as ways to prevent postdural puncture headache, their efficacy remains controversial, and we advise caution with these techniques.