Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2006
Case ReportsAutonomic dysreflexia in a parturient with spinal cord injury.
Autonomic dysreflexia (ADR) is a syndrome of imbalanced reflex sympathetic discharge occurring in patients with spinal cord injury (SCI) at or above the level of splanchnic sympathetic outflow (T6). We present the case of a 29 year-old, gravida 3, para 1 Caucasian female at 28 weeks gestation, with a history of T3 SCI secondary to a gunshot wound 9 years prior, who developed ADR during preterm labor and received epidural anesthesia during 6 days of labor followed by spinal anesthesia for cesarean section. Spinal anesthesia may be superior to epidural anesthesia for providing hemodynamic protection against ADR during cesarean section.
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Acta Anaesthesiol Belg · Jan 2006
Case ReportsPrevention strategy for post dural puncture headache.
We report the anesthetic management of a parturient after an unintentional dural puncture while performing epidural anaesthesia for caesarean section and the strategy to prevent postdural puncture headache (PDPH). We injected the cerebrospinal fluid (CSF) back into the subarachnoid space and then administered intrathecal 1.5 mL 0.5% hyperbaric bupivacaine and fentanyl 20 microg to maintain CSF volume via epidural needle. ⋯ After adding 3 mL of 0.5% isobaric bupivacaine via epidural catheter, sensory block level reached at T4 bilaterally. No PDPH was observed.
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Between 0.1% and 0.2% of surgical patients given general anesthesia remember having been aware during the procedure. Not all, but some of these patients have experienced pain, anxiety or both while being aware. ⋯ The anxiety symptoms may be transient, but can persist in some patients. The majority of available studies on suffering due to awareness are retrospective, and potential selection bias in the studied cohorts should be considered when the likelihood for negative experiences of awareness are discussed.