1/24. Use of remifentanil in a patient with peripartum cardiomyopathy requiring Caesarean section.We describe a case of a 26 yr old primigravida at 39 weeks' gestation, with a diagnosis of peripartum cardiomyopathy, requiring urgent Caesarean section. The patient presented in severe heart failure and active labour. A general anaesthetic, using a target-controlled infusion of propofol and an intravenous infusion of remifentanil, was used to provide stable anaesthesia and analgesia for a successful delivery. The unusual diagnosis of peripartum cardiomyopathy and the potential benefits of the use of remifentanil in high-risk obstetric surgery are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/24. Maternal deaths from anaesthesia. An extract from Why mothers die 1997-1999, the Confidential Enquiries into Maternal Deaths in the United Kingdom.This article is reprinted from Why mothers Die 1997-1999, the fifth report of the Confidential Enquiries into Maternal Deaths in the United Kingdom.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
3/24. Non-fatal amniotic fluid embolism after cervical suture removal.We describe a case of pulmonary oedema occurring at 37 weeks gestation, following the attempted removal of a cervical suture under general anaesthesia. The use of an ultrasound technique to demonstrate the patient's fluid status is described. Signs of amniotic fluid embolism and how it exerts its influence on the circulation are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/24. Pneumomediastinum in labour -- probably not caused by a lumbar epidural anaesthesia.We describe a case of pneumomediastinum and subcutaneous emphysema during labour. The patient had previously received an epidural anaesthesia to alleviate labour pain. We found several reports of subcutaneous emphysema and pneumomediastinum (or pneumothorax) possibly caused by or related to epidural anaesthesia use, but conclude that the epidural anaesthesia was probably not a cause in our case.- - - - - - - - - - ranking = 7keywords = anaesthesia (Clic here for more details about this article) |
5/24. Obstetrical anaesthesia and analgesia in chronic spinal cord-injured women.Improved acute and rehabilitative care and emphasis on integrating patients into society after spinal cord injury is likely to result in increasing numbers of cord-injured women presenting for obstetrical care. Anaesthetists providing care to these women should be familiar with the complications resulting from chronic cord injury and aware that many may be aggravated by the physiological changes of normal pregnancy. These complications include reduced respiratory volumes and reserve, decreased blood pressure and an increased incidence of thromboembolic phenomena, anaemia and recurrent urinary tract infections. patients with cord lesions above the T5 spinal level are at risk for the life-threatening complication of autonomic hyperreflexia (AH) which results from the loss of central regulation of the sympathetic nervous system below the level of the lesion. Sympathetic hyperactivity and hypertension result in response to noxious stimuli entering the cord below the level of the lesion. Labour appears to be a particularly noxious stimulus and patients with injuries above T5 are at risk for AH during labour even if they have not had previous AH episodes. morbidity is related to the degree of hypertension and intracranial haemorrhage has been reported during labour and attributed to AH. We report our experience in providing care to three parturients with spinal cord injuries. Two patients had high cervical lesions, one of whom experienced AH during labour and was treated with an epidural block. The second was at risk for AH having had episodes in the past and received an epidural block to provide prophylaxis for AH. In both cases epidural blockade provided effective treatment and prophylaxis for AH.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
6/24. Anaesthetic management of a parturient with the postural orthostatic tachycardia syndrome: a case report.postural orthostatic tachycardia syndrome encompasses a group of disorders characterized by orthostatic intolerance. We describe the anaesthetic management of analgesia for labour and of Caesarean section in a parturient suffering from this disorder. Worsening of her symptoms during pregnancy was managed with an increase in the dose of beta-blockers taken by the patient. Epidural analgesia was instigated early to attenuate the stress of labour and avoid consequent triggering of a tachycardic response. Slow titration of epidural analgesia and anaesthesia after an adequate fluid preload was undertaken to minimize hypotension and subsequent tachycardia. Neuraxial opioid, combined with non-steroidal anti-inflammatory drugs and bilateral iliohypogastric and ilioinguinal nerve blocks were used to optimize postoperative analgesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
7/24. Management of labour and delivery in patients with intracranial neoplasms.The presence of an intracranial neoplasm (ICN) during pregnancy has serious implications for the anaesthetic management of labour and delivery. The physiological changes of pregnancy and labour are potentially hazardous to women with ICN, but the provision of adequate pain relief during labour reduces the risk to the mother. Extradural anaesthesia is the only technique that provides pain-free labour reliably, but it carries added risks. Three patients are reported who were managed with extradural anaesthesia: two delivered per vaginam and one by Caesarean section. None suffered any complication related to the anaesthetic technique. At present, there are no published data on the influence of anaesthetic management on outcome of labour and delivery in patients with ICN. Anaesthetists should report such cases so that the relative risks of different management strategies may be assessed.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
8/24. Precordial Doppler diagnosis of haemodynamically compromising air embolism during caesarean section.This is a report of a 39-year-old parturient who had a haemodynamically compromising venous air embolism during a repeat Caesarean section under lumbar epidural anaesthesia. The embolism occurred immediately after surgical incision during surgery in the superficial subcutaneous tissues. The diagnosis was made using intraoperative precordial ultrasonic Doppler monitoring which allowed early and successful treatment.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
9/24. Lupus anticoagulant. Implications for obstetric anaesthetists.Circulating lupus anticoagulant occurs in 5-37% of all patients with systemic lupus erythematosus. Its occurrence is not restricted to collagen vascular disease states. Lupus anticoagulant causes a prolongation of certain laboratory coagulation studies yet it is associated in vivo with a history of systemic intravascular thromboses. Placental vessels are also affected. Less than one in six pregnancies complicated by the presence of this auto-antibody is successful. Treatment of afflicted parturients with anti-platelet therapy has increased perinatal survival rates. Derangements in the coagulation profile and concomitant anti-platelet therapy confound the rational use of regional anaesthesia in the management of labour and delivery in these high-risk pregnancies.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
10/24. Epidural anaesthesia in von hippel-lindau disease. Management of childbirth and anaesthesia for caesarean section.The management of childbirth, including epidural anaesthesia for Caesarean section is described in a patient with von hippel-lindau disease. The reasons for the choice of epidural anaesthesia are explained and the anaesthetic significance of the disease is discussed.- - - - - - - - - - ranking = 10keywords = anaesthesia (Clic here for more details about this article) |
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