International journal of obstetric anesthesia
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A 30-year-old woman was admitted to the labour ward at term complaining of symptoms suggestive of raised intracranial pressure which were overlooked. Epidural analgesia was administered following induction of labour and was associated with a clear exacerbation of symptoms. After delivery a CT scan revealed a large cerebello-pontine angle tumour with obstructive hydrocephalus. This case report and literature review demonstrate the importance of a reasonable level of clinical suspicion and a careful neurological examination in patients with such symptomatology to allow sensible and safe guidance through labour.
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Int J Obstet Anesth · Apr 1995
Epidural analgesia with 4 mg of morphine after caesarean section: modulating effect of epidural block compared to general anaesthesia.
Forty patients had epidural catheters placed for analgesia in active labour. For caesarean section patients in the epidural (EA) group (n = 20) had epidural anaesthesia with 0.5% bupivacaine supplemented if necessary with 2% lidocaine with adrenaline. Patients in the general anaesthesia (GA) group (n = 20) had standardized general anaesthesia for surgery. ⋯ Patients in the EA group consumed significantly less pain medication during the first 24 h after surgery (P = 0.0002). Itching was less frequent in the GA group (P = 0.011). It is concluded that epidural administration of 4 mg of morphine produces more effective postoperative pain relief when emergency caesarean section is conducted under epidural than when it is conducted under general anaesthesia.
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Int J Obstet Anesth · Apr 1995
Successful subdural anesthesia for cesarean section and postoperative pain management.
Subdural catheterization is a well described, but uncommon complication of attempted epidural block. Aspiration of blood or cerebrospinal fluid and use of a test dose can help identify venous or subarachnoid catheter placement but do not rule out subdural catheter placement. ⋯ This report describes the early identification of subdural placement of a catheter intended for the epidural space. We present radiologic confirmation of the catheter's location, and describe its use to provide successful anesthesia for cesarean section and postoperative analgesia.
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Int J Obstet Anesth · Apr 1995
Acute pulmonary edema in the post partum and cor triatriatum sinistrum.
A case is described of an apparently healthy young woman in her first pregnancy who presented with acute pulmonary edema in the early postpartum period in the context of mild pregnancy-induced hypertension. After quick improvement in her condition, a Doppler followed by a transesophageal study revealed a left atrial septation with a small atrial septal defect secundum type and moderate mitral regurgitation strongly suggestive of a cor triatriatum sinistrum.