1/46. Anaesthesia for caesarean section in a patient with an intracranial arteriovenous malformation.Intracranial haemorrhage from an arteriovenous malformation (AVM) during pregnancy is rare but may result in significant maternal and fetal morbidity and mortality. In the untreated patient with an AVM, the best mode of delivery remains debatable with most obstetricians preferring a caesarean section in order to avoid Valsalva manoeuvres associated with vaginal delivery. We describe the administration of epidural anaesthesia for such a parturient undergoing Caesarean section and the anaesthetic implications.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/46. 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 = 21.78362304534keywords = subarachnoid haemorrhage, haemorrhage, subarachnoid (Clic here for more details about this article) |
3/46. Combined spinal-epidural anesthesia for cesarean section in a patient with peripartum dilated cardiomyopathy.PURPOSE: To report a case of peripartum dilated cardiomyopathy associated with morbid obesity and possible difficult airway presenting for elective cesarean section, which was successfully managed with combined spinal-epidural anesthesia. CLINICAL FEATURES: A morbidly obese parturient with a potentially difficult airway, suffering from idiopathic peripartum cardiomyopathy (ejection fraction 20%), was scheduled for an elective cesarean section. A combined spinal epidural anesthesia was performed and 6 mg of bupivacaine were injected into the subarachnoid space. This was supplemented after 60 min with 25 mg of bupivacaine injected epidurally. The patient's hemodynamic status was monitored with direct intra-arterial blood pressure and central venous pressure measurements. The patient's perioperative course was uneventful. CONCLUSION: In patients suffering from peripartum cardiomyopathy, undergoing cesarean section, combined spinal-epidural anesthesia may be an acceptable anesthetic alternative.- - - - - - - - - - ranking = 0.80756060722536keywords = subarachnoid (Clic here for more details about this article) |
4/46. Endovascular treatment of acutely ruptured intracranial aneurysms in pregnancy.intracranial aneurysm rupture is responsible for important morbidity and mortality during pregnancy. We report 2 cases of subarachnoid hemorrhage in pregnant women resulting from ruptured aneurysms. Both patients were treated by endovascular approach. Successful maternal and fetal outcome were achieved in both cases without craniotomy and aneurysmal surgical exposure.- - - - - - - - - - ranking = 0.80756060722536keywords = subarachnoid (Clic here for more details about this article) |
5/46. Peripartum management of a patient with Glanzmann's thrombasthenia using Thrombelastograph.We describe the perioperative management of a 31-yr-old primipara with Glanzmann's thrombasthenia, who required urgent Caesarean delivery at 33 weeks' gestation. Peripartum haemorrhage was inevitable and was pre-empted by transfusion of multiple blood products, the effects of which were monitored by Thrombelastograph. The blood products given are discussed.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
6/46. Probable dystonic reaction after a single dose of cyclizine in a patient with a history of encephalitis.A patient underwent an emergency Caesarean section under general anaesthesia for an antepartum haemorrhage. Following delivery of a live infant, cyclizine was administered in accordance with departmental anti-emetic protocol. On awakening she was confused, slow to articulate and had slurred speech. A computed tomography (CT) scan, which was performed to exclude an intracranial event, was normal. Her symptoms were suggestive of a lingual-facial-buccal dyskinesia as seen with dopamine antagonists. A presumptive diagnosis of a dystonic reaction to cyclizine was made. She received two doses of procyclidine before her symptoms completely resolved. cyclizine has had a resurgence in popularity owing to the recent withdrawal of droperidol and anaesthetists should be aware that, although extremely rare, dystonic reactions may occur with this agent.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
7/46. urinary bladder carcinoma as apparent cause of antepartum haemorrhage in pregnancy.A 34-year-old multipara presented with painless profuse genital bleeding during the third trimester of pregnancy in a state of hemorrhagic shock. Haematuria because of urinary bladder carcinoma was found to be the cause of bleeding. cystoscopy was useful for accurate diagnosis as well as for achieving haemostasis. This case emphasizes the possibility and importance of haematuria when dealing with a patient with antepartum haemorrhage.- - - - - - - - - - ranking = 5keywords = haemorrhage (Clic here for more details about this article) |
8/46. General anaesthesia using remifentanil for caesarean section in parturients with critical aortic stenosis: a series of four cases.Although heart disease is now the joint leading cause of maternal mortality in the UK, critical aortic stenosis is rarely encountered in parturients. Caesarean section is advisable in these patients to minimise the haemodynamic stress of labour and delivery. The use of an opioid-based general anaesthetic technique also helps to maintain cardiovascular stability. During a two-year period, four women with critical aortic stenosis requiring caesarean section presented to our institution. In all women, a rapid sequence induction of anaesthesia was performed using etomidate 0.1 to 0.2 mg.kg(-1), suxamethonium 1.5 mg.kg(-1) and remifentanil 2 to 4 micrograms.kg(-1). Anaesthesia was then maintained with isoflurane, nitrous oxide and a remifentanil infusion at 0.05 to 0.15 micrograms.kg(-1)min(-1). There was good haemodynamic stability throughout, except for a short period in one patient who became hypotensive after a significant post-partum haemorrhage secondary to uterine atony. All parturients were successfully extubated at the end of surgery and made excellent postoperative recoveries. Neonates were born in good condition with Apgar scores of 10, 9, 6 and 5 at 1 min and 10, 10, 10 and 10 at 5 min. We suggest that remifentanil is an ideal agent for parturients with severe aortic stenosis requiring general anaesthesia for caesarean section. Remifentanil provides cardiovascular stability in conjunction with rapid emergence from anaesthesia in the parturient and minimal side effects in the neonate.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
9/46. pregnancy and subarachnoid hemorrhage: a case report.Cerebrovascular diseases are rare in pregnancy and mostly caused by rupture of an arterial aneurysm. We present the case of a pregnant woman at 36 weeks of gestation who had a subarachnoid hemorrhage resulting from rupture of an unknown aneurysm, and who underwent a cesarean section and an endovascular treatment to embolize the aneurysm.- - - - - - - - - - ranking = 4.0378030361268keywords = subarachnoid (Clic here for more details about this article) |
10/46. Ruptured arteriovenous malformation and subarachnoid hemorrhage during emergent cesarean delivery: a case report.Cerebral arteriovenous malformations (AVMs) are formed from a vascular plexus of direct arterial-venous connections that progressively dilate, making them prone to rupture. They are frequently asymptomatic and often remain undiagnosed until they present with associated symptoms of headaches, seizures, neurological deficits, or hemorrhages. Occurrence of headache during pregnancy and labor is associated with several diverse etiologies, making definitive diagnosis extremely difficult. This case report describes the anesthetic management of a 31-year-old laboring patient who first complained of headache, then suffered an acute subarachnoid hemorrhage secondary to rupture of a previously undiagnosed AVM during emergent cesarean delivery.- - - - - - - - - - ranking = 4.0378030361268keywords = subarachnoid (Clic here for more details about this article) |
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