International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2006
An analysis of the need for anesthetic interventions with differing concentrations of labor epidural bupivacaine: an observational study.
Labor epidural analgesia techniques using lower concentrations of bupivacaine are designed to maintain pain control with fewer side effects such as hypotension and motor block. However, the increase in sensation may allow breakthrough pain resulting in the need for additional interventions. We examined the number of interventions, both for analgesia and for treatment of side effects, required when using three concentrations of bupivacaine. ⋯ Neither the total interventions nor intervention rate per hour varied significantly with the concentrations of bupivacaine used in this study. Lower concentrations produced fewer side effects including hypotension, while the higher concentration resulted in less breakthrough pain.
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Int J Obstet Anesth · Jul 2006
Case ReportsFoot drop after spinal anesthesia in a patient with a low-lying cord.
Damage to the spinal cord/conus medullaris due to incorrect identification of the lumbar space is a known complication of lumbar puncture. However, damage to a low-lying cord using an appropriate interspace is extremely rare. ⋯ She developed right foot drop immediately after surgery, which gradually recovered over the next 10 months. Magnetic resonance imaging revealed a low lying cord with a fatty filum terminale and intramedullary T2 hyperintensity, suggestive of needle damage.
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Int J Obstet Anesth · Jul 2006
Case ReportsAnesthetic management for emergency cesarean section in a patient with severe valvular disease and preeclampsia.
Wider selection of young patients for prosthetic valve replacement for valvular heart disease has resulted in an increase in number of women with heart disease reaching childbearing age. Such patients presenting in labor for emergency cesarean section require special consideration. ⋯ The goals of our anesthetic management included (1) careful airway management (2) maintaining stable hemodynamics (3) optimizing fluid status, and (4) preventing seizures. Issues related to management of patients with severe valvular disease, prosthetic valves and complications due to anticoagulant therapy during pregnancy are discussed.
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Int J Obstet Anesth · Jul 2006
Case ReportsUndiagnosed phaeochromocytoma mimicking severe preeclampsia in a pregnant woman at term.
We report an unusual case of phaeochromocytoma in pregnancy. The patient presented with severe hypertension, visual disturbances, proteinuria, glycosuria and pulmonary oedema at 38 weeks' gestation. The initial diagnosis was severe preeclampsia, but rapid deterioration of the fetus necessitated an emergency caesarean section under general anaesthesia, following which the maternal condition deteriorated rapidly. ⋯ Post mortem examination of the mother revealed a 5.5-cm tumour of the right adrenal gland confirmed histologically as a phaeochromocytoma. We examine the diagnostic dilemmas of this case and consider the treatment and management options when faced with a critically ill mother and the need to deliver her fetus by emergency caesarean section. We also question the clinical priorities during management of a sudden deterioration in both maternal and fetal health.