Anaesthesia
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A case of amniotic fluid embolus is described with an acute onset occurring 90 min after surgical delivery in a mildly pre-eclamptic primigravida undergoing Caesarean section for a breech presentation. Severe disseminated intravascular coagulation and massive postpartum haemorrhage were corrected and she went on to make a full recovery. The pathophysiology of amniotic fluid embolism is discussed and new diagnostic tests are reviewed. It is suggested that in this patient an amniotic fluid collection in dilated uterine veins was mobilised as venous tone returned following the offset of spinal anaesthesia and sympathetic blockade.
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Case Reports
Anaesthesia for caesarean section in a patient with Klippel-Feil syndrome. The use of a microspinal catheter.
A 34-year-old woman with severe kyphoscoliosis, an immobile cervical spine, and short stature due to the Klippel-Feil syndrome presented for elective Caesarean section. She expressed a strong desire to remain awake during the procedure. We chose a technique using a spinal microcatheter to provide spinal anaesthesia on the basis that incremental control of the dose of bupivacaine would reduce the risk of 'high' block. ⋯ A total of 6.25 mg heavy bupivacaine, 7.5 mg plain bupivacaine, and 10 micrograms fentanyl were administered over 20 min. This provided anaesthesia up to T5 without significant effects on respiratory or cardiovascular function. The patient was successfully delivered of a healthy boy.
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Clinical Trial Controlled Clinical Trial
Correct positioning of the epiglottis for application of the Brain laryngeal mask airway.
Positioning of the epiglottis when the Brain laryngeal mask airway is in place was studied in 20 adult patients, using a new technique of insertion. The laryngeal mask was inserted when the anterior displacement of the mandible extended the epiglottis, thereby the providing an excellent airway in all patients. In 10 out of these 20 patients, the conventional technique of insertion revealed an incomplete extension of the epiglottis, and inadequate opening of the laryngeal inlet. It was concluded that the anterior displacement of the mandible during insertion of the laryngeal mask enhances the opening of the larynx, the result being an excellent airway.