1/4. alfentanil for urgent caesarean section in a patient with severe mitral stenosis and pulmonary hypertension.We present the case of a parturient with severe mitral stenosis and pulmonary hypertension who received general anaesthesia using alfentanil for urgent Caesarean section. alfentanil promoted haemodynamic stability and allowed immediate postoperative extubation. Epidural morphine provided postoperative analgesia. This combination permitted early ambulation and prevention of thromboembolism. A disadvantage of this technique, neonatal respiratory depression, was promptly reversed with a single dose of naloxone. The anaesthetic management of mitral stenosis in pregnancy is discussed and the neonatal pharmacokinetics of maternally administered alfentanil are presented.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/4. postoperative complications of dystrophia myotonica.A 44-year-old man with known mitral stenosis presented for minor surgery. Anaesthesia was induced with fentanyl, droperidol and etomidate and maintained with nitrous oxide, oxygen and vecuronium. Surgery and anaesthesia were uneventful but the postoperative course was stormy, with respiratory arrest, haemophilus pneumonia, refractory cardiac dysrhythmias and gastrointestinal atony. A diagnosis of dystrophia myotonica was made after 3 weeks in the intensive care unit, and he spent 6 weeks in hospital. A high index of suspicion for this disease must be maintained and intensive care facilities and monitoring should be available for all procedures.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/4. Invasive monitoring and anaesthetic management of a parturient with mitral stenosis.The anaesthetic management of a parturient with mitral stenosis is presented and discussed. In particular, the beneficial effects of epidural anaesthesia for vaginal delivery are described with respect to the significant improvement noted in haemodynamic parameters. The information derived from the pulmonary artery catheter greatly assisted the management of the patient throughout labour and in the puerperium.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/4. Spinal anaesthesia for caesarean section. Management of a parturient with severe cardiovascular disease.A parturient with severe mitral valve disease and pulmonary oedema was admitted to the labour ward. fetal distress was also present. An emergency Caesarean section was undertaken under spinal blockade. The reasons for the choice of this technique are discussed.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |