1/3. Intramuscular ketamine in a parturient in whom pre-operative intravenous access was not possible.We describe the management of a 23-yr-old woman with extreme needle and mask phobia, presenting for an emergency Caesarean section for fetal distress. She also suffered from spina bifida cystica with no sensation from mid thigh. Regional anaesthesia, rapid sequence induction, and gaseous induction were not possible. She was managed successfully with i.m. ketamine followed by a more conventional anaesthetic technique.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Calculus anuria in a spina bifida patient, who had solitary functioning kidney and recurrent renal calculi.STUDY DESIGN: Clinical case report with comments by colleagues from austria, belgium, germany, japan, and poland. OBJECTIVES: To discuss challenges in the management of spinal bifida patients, who have marked kyphoscoliosis and no vascular access. SETTING: Regional spinal injuries Centre, Southport, UK. methods: A female patient, who was born with spina bifida, paraplegia and solitary right kidney, had undergone ileal loop urinary diversion. Renal calculi were noted in 1986. Percutaneous nephrostolithotomy was performed in 1989 and there was no residual stone fragment. However, she developed recurrence of calculi in the lower pole of the right kidney in 1991. Intravenous urography, performed in 1995, revealed right staghorn calculus and hydronephrosis. Chest X-ray showed markedly restricted lung volume due to severe kyphoscoliosis. In 2000, she was declared unsuitable for anaesthesia due to a lack of venous access and a high likelihood of difficulty in weaning off the ventilator in the postoperative period. In June 2002, she developed anuria (urine output=18 ml/24 h) due to ball-valve-type obstruction by a renal stone at the ureteropelvic junction. urea: 14.4 mmol/l; creatinine: 236 microl/l. Ultrasound showed right hydronephrosis. Percutaneous nephrostomy was performed. RESULTS: Following relief of urinary tract obstruction, there was postobstructive diuresis (3765 ml/24 h). However, the patient expired 19 days later due to progressive respiratory failure. CONCLUSION: In this spina bifida patient, who had reached the age of 35 years, severe kyphoscoliosis and lack of vascular access presented insurmountable challenges to implement the desired surgical procedure for removal of stones from a solitary kidney.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/3. Spinal catheter anaesthesia for caesarean section in a patient with spina bifida.A patient with grossly deformed vertebral anatomy, scheduled for elective Caesarean section, expressed her wish to stay fully awake during the procedure. Epidural anaesthesia was considered to be impracticable, while dural puncture appeared possible only at thoracic level. Spinal anaesthesia using a subarachnoid catheter placed at T7-8 was employed successfully.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |