1/19. Spinal haematoma following epidural anaesthesia in a patient with eclampsia.A patient with a twin pregnancy required a Caesarean section for severe pre-eclampsia. Her platelet count was 71 x 10(9).l-1. Epidural anaesthesia was performed after platelet transfusion. A spinal epidural haematoma was diagnosed postoperatively. A generalised tonic-clonic seizure sparing the lower limbs enabled early diagnosis to be made. The patient recovered with no permanent neurological damage after laminectomy and clot removal. The risks and benefits of regional techniques require careful consideration, and postoperative monitoring for recovery of neural blockade is essential.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/19. Remifentanil in emergency caesarean section in pre-eclampsia complicated by thrombocytopenia and abnormal liver function.We describe the use of remifentanil in a woman with severe pre-eclampsia who presented for emergency caesarean section. Remifentanil was effective in obtunding the hypertensive response to laryngoscopy and intubation. Previous studies have found no significant adverse effects of remifentanil on the neonate. With its short duration of action, the use of this new opioid has several potential advantages in the above setting. Further studies are required to explore the use of remifentanil as an adjunct to obstetric general anaesthesia.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
3/19. Anaesthesia for caesarean section in a patient with recent subarachnoid haemorrhage and severe pre-eclampsia.Subarachnoid haemorrhage is a leading 'indirect' cause of maternal death in the UK. We describe the case of a 43-year-old woman who presented with headache, photophobia and neck stiffness of sudden onset at 32 weeks' gestation. Cerebral computed tomography demonstrated subarachnoid blood in the cisterns around the midbrain, and oral nimodipine was started to prevent vasospasm. Preparations were made for endovascular coil embolisation in the event of identification of a posterior circulation aneurysm. However, angiography under general anaesthesia failed to reveal any vascular abnormality. On emergence from anaesthesia, headache persisted, and over the next 24 h severe pre-eclampsia developed. magnesium sulphate was started, and urgent Caesarean section performed under general anaesthesia without incident. The rationale for the neuroradiological, obstetric and anaesthetic management is discussed.- - - - - - - - - - ranking = 0.6keywords = anaesthesia (Clic here for more details about this article) |
4/19. Anaesthetic management of splenectomy in Evan's syndrome during pregnancy with pregnancy induced hypertension.The management of idiopathic thrombocytopenic purpura (ITP) during pregnancy, especially with ongoing bleeding diathesis, has not been highlighted sufficiently in the literature. Aortocaval compression and reduction in uteroplacental circulation resulting in foetal hypoxia and acidosis, Mendelson's syndrome due to gravid uterus, trauma to airway with resultant haemorrhage and aspiration into lungs, compromised airway due to short neck, anasarca and heavy breast, limitation in using invasive monitoring and regional anaesthesia and uncontrolled bleeding leading to placental hypoperfusion and foetal hypoxia are some of the important risks. In the present case report, anaesthetic management for splenectomy during pregnancy complicated with pregnancy induced hypertension and bleeding diathesis secondary to ITP is described with reference to above risks.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
5/19. Recurrent post-partum seizures after epidural blood patch.There are many causes for headaches after childbirth. Even though postdural puncture headache (PDPH) has to be considered in a woman with a history of difficult epidural anaesthesia, pre-eclampsia should always be excluded as an important differential diagnosis. We report a case with signs of late-onset pre-eclampsia where administration of an epidural blood patch (EBP) was associated with eclampsia. A hypothetical causal relationship between the EBP and seizures was discarded on the basis of evidence presented in this report.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
6/19. General anaesthesia for emergency caesarian section in a patient with Eisenmenger's syndrome and pre-eclampsia.pregnancy is poorly tolerated in patients with Eisenmenger syndrome (ES) with maternal mortality of 30-50%. Physiological changes of pregnancy decreases systemic vascular resistance that further aggravates the bi-directional or right to left shunt associated with ES. When it occurs with eclampsia, the morbidity and mortality are even higher. We report a case of 30 weeks pregnant woman with ES, who underwent emergency caesarian section because of pre-eclampsia. The intra-operative course was uneventful but she died on the second post-operative day. Post-operatively she was managed by the cardiologist in the coronary care unit. The probable cause being that she was over transfused, as the fluid status was not assessed by any invasive monitoring (like CVP). It was concluded that patients should be monitored closely in the post-operative period in the intensive care unit with complete invasive monitoring for up to a week to prevent factors resulting in worsening of the shunt (such as fluid balance) and thromboembolic phenomenon.- - - - - - - - - - ranking = 0.8keywords = anaesthesia (Clic here for more details about this article) |
7/19. Undiagnosed phaeochromocytoma mimicking severe preeclampsia in a pregnant woman at term.We report an unusual case of phaeochromocytoma in pregnancy. The patient presented with severe hypertension, visual disturbances, proteinuria, glycosuria and pulmonary oedema at 38 weeks' gestation. The initial diagnosis was severe preeclampsia, but rapid deterioration of the fetus necessitated an emergency caesarean section under general anaesthesia, following which the maternal condition deteriorated rapidly. Differential diagnoses included pulmonary embolus, cardiomyopathy, amniotic fluid embolus and ischaemic/embolic cerebrovascular accident. Despite aggressive maximal treatment, mother and baby died 36 h later. Post mortem examination of the mother revealed a 5.5-cm tumour of the right adrenal gland confirmed histologically as a phaeochromocytoma. We examine the diagnostic dilemmas of this case and consider the treatment and management options when faced with a critically ill mother and the need to deliver her fetus by emergency caesarean section. We also question the clinical priorities during management of a sudden deterioration in both maternal and fetal health.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
8/19. Neurological cause of late postpartum seizures.A 32-year-old primigravida showed signs of pre-eclampsia before delivery of a healthy boy at term. The CSF-space was accidentally punctured during epidural anaesthesia in labour. One day later hypertension was noted and the patient had a single generalized fit. For the next three weeks she had postural headaches, fluctuating hypertension, intermittent hearing loss and double-vision. On the 22nd day of postpartum, the patient had the first of a series of partial and later generalized seizures, followed by hemiparesis, alteration of consciousness, and finally slow recovery with corticosteroid therapy. Bilateral subdural effusions and generalized meningeal thickening were found on MR scans. Repeated MRI excluded sinus thrombosis and documented the response to treatment.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
9/19. Anaesthesia for caesarean section in a pre-eclamptic patient with Ebstein's anomaly.Anaesthetic management for Caesarean section in a pre-eclamptic patient with Ebstein's anomaly and a right to left intracardiac shunt was accomplished under general anaesthesia. air bubbles in the venous line were meticulously eliminated to prevent paradoxical air emboli. A rapid sequence induction using standard doses of thiopentone and succinylcholine did not result in loss of consciousness and muscle relaxation was inadequate for endotracheal intubation. This problem must be anticipated in patients with extremely enlarged right atria and the dose of induction agents should be increased. Carefully controlled epidural anaesthesia may be used if the cardiac reserve is adequate.- - - - - - - - - - ranking = 0.4keywords = anaesthesia (Clic here for more details about this article) |
10/19. Anaesthetic management of caesarean section for a mother with pre-eclampsia, the klippel-feil syndrome and congenital hydrocephalus.A mother with the klippel-feil syndrome, congenital hydrocephalus and increased intracranial pressure presented for delivery by Caesarean section at 33 weeks because of pre-eclampsia. Anaesthetic management comprised awake intubation using the fibreoptic bronchoscope, followed by induction and maintenance of general anaesthesia for the delivery of a live male infant. This case report describes the problems arising under these circumstances and the relative merits of different anaesthetic techniques.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
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