1/3. Anaesthetic management of emergency caesarean section in a patient with Noonan's syndrome--case report and literature review.patients with Noonan's syndrome present a multiplicity of challenges to the anaesthetist, particularly with regard to cardiovascular, spinal, and airway abnormalities. Anaesthetist may have to deal with an increasing number of these patients presenting to anaesthesia departments requesting analgesia and anaesthesia for surgery of labour. Early detection and planing between obstetricians, midwives and anaesthetists will help successful management of these patients. Alternative methods of management should be discussed fully with patients. Regional anaesthesia, although may be difficult in these patients, is a safe alternative compared to expensive general anaesthesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. General anaesthesia for caesarean section in a parturient with Noonan's syndrome.We describe the anaesthetic management of a parturient with Noonan's syndrome. Her problems included severe cardiac disease, facial abnormalities and extreme phobia to needles. After intrauterine death at 30 weeks gestation, induction of labour was attempted and extradural analgesia initiated using low-dose bupivacaine. She failed to progress and underwent Caesarean section under general anaesthesia using awake oral fibreoptic intubation.- - - - - - - - - - ranking = 1.25keywords = anaesthesia (Clic here for more details about this article) |
3/3. Anaesthesia in a parturient with Noonan's syndrome.PURPOSE: To report the management of labour analgesia and subsequent anaesthesia for postpartum bleeding in a 19-yr-old parturient with Noonan's syndrome. CLINICAL FEATURES: The patient presented in active labour at 36-wk gestation. She was known to have Noonan's syndrome and had been assessed regularly throughout pregnancy. Features of the syndrome exhibited by the patient included typical facies, chest skeletal abnormalities, pulmonary valve dysplasia, mental retardation and lymphoedema. In addition, she had factor xi deficiency (0.46 mg.L-1) and thrombocytopenia (92 x 10(9).L-1), previously unreported in a parturient with this syndrome. Although epidural analgesia may have been considered the labour analgesic technique of choice, the risk of epidural haematoma caused by her bleeding diathesis made this unacceptable. This risk was balanced against the possibility of a potentially difficult intubation due to facial abnormalities, should emergency operative delivery become necessary. Labour analgesia was provided with intravenous patient controlled opioid analgesia (fentanyl 25 micrograms bolus, five minute lockout) despite her mental retardation. dilatation and curettage required general anaesthesia after intubation with awake direct laryngoscopy using cautious sedation. CONCLUSION: Noonan's syndrome is characterised by multi-system involvement, requiring thorough preoperative assessment of cardiovascular, skeletal, haematological and central nervous systems. Clotting and platelet defects considerably restrict the possible analgesic and anaesthetic options for labouring patients with this syndrome.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |