Masui. The Japanese journal of anesthesiology
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Case Reports
[Urgent cesarean section under combined spinal and epidural anesthesia in a patient with aortitis syndrome].
We report the anesthetic management of a patient with aortitis syndrome using combined spinal and epidural anesthesia. A 28-year-old gravida with aortitis syndrome accompanied by faints was scheduled for an urgent cesarean section. Combined spinal and epidural anesthesia was thought to be better for this case in order to monitor the cerebral circulation by her consciousness level and to reduce the hemodynamic change during surgery as compared to spinal or epidural anesthesia alone. ⋯ The level of analgesia reached to Th 6 without major hemodynamic changes. A healthy 2740 g infant was delivered and she had an uneventful recovery. We conclude that combined spinal and epidural anesthesia is useful in a patient with aortitis syndrome undergoing an urgent cesarean section in order to monitor the cerebral circulation by the consciousness level and to reduce the hemodynamic change.
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We investigated the efficacy and untoward effects of low doses of propofol for intrathecal morphine-induced pruritus. Twenty gynecological and obstetric surgical patients received spinal anesthesia with 0.5% tetracaine and phenylephrine, as well as 0.2 mg morphine. Seven of them (35%) complained pruritus graded according to the treatment necessary in the postoperative period. ⋯ One patient was resistant to treatments by 20 mg of propofol and 0.1 mg of naloxone. Three patients transiently fell in sleep even after administering 10 mg of propofol. The authors conclude that low dose propofol is effective in treating intrathecal morphine-induced pruritus, although it may transiently causes hypnosis in postoperative patients.