1/13. 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) |
2/13. 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) |
3/13. Anaesthetic management of the parturient with protein s deficiency and lumboperitoneal shunt.Protein S, a vitamin k-dependent plasma protein, is a cofactor for protein c, an essential component of the regulatory system of coagulation. We describe the anesthetic management of a parturient with protein s deficiency and an indwelling lumboperitoneal shunt, which was placed following transverse and sagittal sinus thrombosis. She was treated with aspirin and enoxaparin during pregnancy and underwent caesarean section under general anaesthesia without complication.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
4/13. Management of a parturient with paroxysmal nocturnal haemoglobinuria.We present the case of a 30-year-old parturient diagnosed in the first trimester of her first pregnancy as having paroxysmal nocturnal haemoglobinuria. pancytopenia necessitated regular transfusion of blood products. The risks of infection, haemorrhage and thrombosis, in the presence of severe thrombocytopenia, mild neutropenia and prophylactic anticoagulation, posed management challenges. We discuss the pathophysiology of paroxysmal nocturnal haemoglobinuria and the impact of pregnancy on the disorder, particularly on maternal morbidities such as thrombosis. The issues relevant to antenatal and peripartum obstetric, haematological and anaesthetic care for vaginal delivery are considered. Severe thrombocytopenia proved a contraindication to regional techniques and she required general anaesthesia for evacuation of a retained placenta. The post-partum period was complicated by fever and a requirement for blood products. Management of these problems, of prophylactic anticoagulation and subsequent therapy, are discussed.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
5/13. Spontaneous cervical epidural haematoma during pregnancy.Spontaneous cervical epidural haematoma is very rare during pregnancy. We describe a woman who presented with tetraplegia at 41 weeks of pregnancy. She had no previous history of any relevant medical disorder. Her upper level of anaesthesia was at the second thoracic segment. The condition was diagnosed by magnetic resonance imaging, and both caesarean section and decompression were conducted 12 hours after the event. The neurological deficit showed little recovery. histology was non-specific and follow-up magnetic resonance imaging showed spinal cord ischaemia. The prognosis in this condition depends on the interval of time between onset and decompression.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
6/13. Anaesthetic dilemma: spinal anaesthesia in an eclamptic patient with mild thrombocytopenia and an "impossible" airway.We present our anaesthetic management of a 27-year-old woman with antepartum eclampsia, mild thrombocytopenia, difficult airway and clinical evidence of impending upper airway obstruction. She required urgent delivery by caesarean section, which was conducted uneventfully under spinal anaesthesia. We discuss the management conundrums presented by this case and why we chose spinal anaesthesia over other anaesthetic options.- - - - - - - - - - ranking = 1.2keywords = anaesthesia (Clic here for more details about this article) |
7/13. acupuncture for acute postoperative pain relief in a patient with pregnancy-induced thrombocytopenia--a case report.A 39 year old woman, scheduled for elective caesarean section in her second pregnancy, developed thrombocytopenia. Therefore, at the time of surgery, spinal anaesthesia and non-steroidal analgesic drugs were avoided and she was given a standard general anaesthetic procedure including fentanyl 100 microg and morphine 10 mg. In the early postoperative period she received tramadol 100 mg and a further 10 mg of morphine. These drugs did not control her pain, but caused side effects--in particular nausea and retching. acupuncture to LI4 and PC6 on the right side produced dramatic pain relief within minutes.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
8/13. Management of pregnancy in a patient with beta thalassaemia major.beta thalassaemia is one of the world's most wide-spread monogenetic disorders. Advances in the management of beta thalassaemia major by extensive blood transfusions and chelation therapy have improved survival of patients into adult life. Due to the prolonged life expectancy and improvements in quality of life, pregnancy has now become an important issue for patients and clinicians. We report a case of a pregnant patient with beta thalassaemia major who underwent a successful caesarean section under spinal anaesthesia. The multidisciplinary approach to management of beta thalassaemia major and pregnancy is discussed.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
9/13. Technique of anaesthesia in pulmonary hypertension and thrombophilia in early pregnancy.Pulmonary hypertension in pregnancy is a rare condition but is associated with a high mortality. We report the case of a 29 year old female in early pregnancy with protein c and S deficiency with recurrent deep venous thrombosis and pulmonary embolism and subsequent secondary pulmonary hypertension. The patient was counselled and consented for termination of pregnancy with tubal sterilization. She was administered continuous spinal anaesthesia with invasive monitoring. The successful anaesthetic management of this condition is described.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
10/13. Epidural anaesthesia and von Willebrand's disease.A case is described of a primiparous patient with Von Willebrand's type 1 disease and diabetes who presented at 36 weeks' gestation for Caesarean section. This was performed under epidural anaesthesia in the absence of any coagulation disorder. The effects of pregnancy on coagulation factors in this disorder are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
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