International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2010
The intradural space: the fourth place to go astray during epidural block.
Considerable uncertainty exists regarding accidental injection of local anaesthetic into the 'subdural space' during attempted epidural block. A whole range of clinical findings, from excessively high to failed blocks has been reported although many of these findings appear difficult to explain on the basis of our current knowledge of the anatomy. The existence of another, adjacent space, the intradural space, is postulated. ⋯ A review of electron microscopy studies suggested that a 'secondary' subdural space could be opened up by trauma in the distal layers of the dura. Our findings suggest that injection into this 'intradural' space can occur, resulting in an initially inadequate neuraxial block with limited spread. Further volumes of local anaesthetic can be expected to produce satisfactory block, probably as a result of escape to the epidural space. However, late spread to the subdural or subarachnoid space may occur.
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Int J Obstet Anesth · Apr 2010
Case ReportsAcute magnesium toxicity in an obstetric patient undergoing general anaesthesia for caesarean delivery.
Magnesium is commonly used in the prevention of eclampsia. Reports of acute toxicity are rare and we are not aware of detailed management algorithms. ⋯ The patient was managed with controlled ventilation, further sedation, intravenous calcium gluconate, forced diuresis and dextrose-insulin infusion. We present a guideline for the management of life-threatening magnesium toxicity and discuss measures that may prevent future similar occurrences.