1/3. maternal death following epidural anaesthesia for caesarean section delivery in a patient with unsuspected sepsis.sepsis in the parturient may be difficult to recognize in light of the physiological changes associated with pregnancy. The purposes of this report are to highlight the signs and symptoms which indicate an underlying septic process and the management of these patients in the peripartum period. This 32-yr-old GII PI woman with twin gestation presented at 36 wk in labour. Her temperature was 35.3 degrees C, she was normotensive and had a normal white blood cell count. After epidural anaesthesia was administered for Caesarean section, she became apnoeic, pulseless and unresponsive. Despite aggressive cardiopulmonary resuscitation, neither she nor her twin babies survived. Post mortem blood work revealed a considerable left shift of her white blood count (> 60% bands) and an anion gap acidosis. autopsy revealed evidence of widespread Group A beta-haemolytic streptococcal sepsis. Diagnosis of sepsis in the parturient involves assessment of the patient's temperature, WBC and differential and acid-base status. Evaluation of the intravascular volume must precede anaesthetic intervention. Epidural anaesthesia may be considered in the labouring and Caesarean section patient who has been fluid-resuscitated. Emergency operative delivery may result in cardiovascular compromise in the patient with severe sepsis.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Anaesthetic management of a neonate with prenatally diagnosed cervical tumour and upper airway obstruction.We report the anaesthetic management of a mother, and airway management of a neonate with a prenatal diagnosis of cervical cystic hygroma causing upper airway obstruction. The mortality of such neonates due to upper airway obstruction is reported to exceed 20% following deliveries. Elective Caesarean section was performed under general anaesthesia, and in utero tracheal intubation of the neonate was accomplished under uninterrupted maternal-fetal circulation. By utilizing isoflurane and ritodrine, the heart rate of the neonate remained between 120 to 150 bpm for four minutes following uterine incision. We believe that it is important that a multidisciplinary approach be initiated for planning of airway management of the neonate soon after the diagnosis is made. laryngoscopy blades larger than normal for neonates, and a portable Doppler to monitor the viability of the neonate were found to be useful in the management of the neonate during in utero tracheal intubation. Although estimated blood loss was not increased, nor did uterine atony occur postoperatively despite the use of ritodrine during Caesarean section, the efficacy and safety of ritodrine to delay placental detachment have not been proved.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
3/3. Anaesthesia for caesarean section in a patient receiving high dose amiodarone for fetal supraventricular tachycardia.We report the anaesthetic management of a Caesarean section in a woman treated with high dose amiodarone for fetal supraventricular tachycardia. Most of the interactions between anaesthesia and amiodarone therapy previously reported were observed during general anaesthesia. We therefore chose epidural anaesthesia using incremental doses of lignocaine 2% with adrenaline and fentanyl. This technique appeared to be safe, but since severe refractory vasodilation with hypotension may occur, potent vasopressor agents should be immediately available.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |