International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2003
Regional blockade for delivery in women with scoliosis or previous spinal surgery.
We conducted a prospective observational study between 1992 and 2001 identifying obstetric patients with untreated or surgically corrected scoliosis or lumbar-sacral fusion surgery. The regional techniques for labour and delivery that were offered were epidural analgesia, combined spinal epidural anaesthesia (CSE), single shot spinal or continuous spinal anaesthesia (CSA) depending on the degree of scoliosis, previous surgery, cardio-respiratory compromise and planned mode of delivery. Forty women were included in the study, one woman with two separate deliveries, giving 41 cases for analysis. ⋯ From a total of 19 CSA techniques attempted sixteen catheters were successfully inserted and produced good analgesia or anaesthesia for vaginal or operative delivery in 12 women (63%). There was one case of post dural puncture headache following a CSA for labour and delivery. We discuss the choices available for regional anaesthetic techniques in scoliotic women and the relative merits of each.
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Int J Obstet Anesth · Jan 2003
Continuous spinal analgesia for labor pain in a parturient with aortic stenosis.
Aortic stenosis in pregnancy carries a high fetal and maternal morbidity and mortality. Spinal analgesia/anesthesia is considered by many to be contraindicated in these patients. The rapid onset of sympathetic block induces hypotension, which can result in myocardial hypoperfusion and myocardial ischemia. ⋯ Pure intrathecal opioid analgesia was used initially to maintain hemodynamic stability. However after two bolus administrations of sufentanil, analgesia was further maintained using ropivacaine and sufentanil. A spinal catheter was chosen to provide reliable anesthesia, which could be extended rapidly for cesarean section.
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We present the first report of epidural analgesia in a parturient with pseudoxanthoma elasticum. This rare inherited disorder of elastic tissue is characterised by skin changes but also has multi-system manifestations. The consequences of pseudoxanthoma elasticum for the obstetric anaesthetist are reviewed. This case highlights the importance of antenatal anaesthetic referral for patients with multi-system disease.