Canadian journal of anaesthesia = Journal canadien d'anesthésie
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This five-year retrospective study reviews our experience with epidural obstetric analgesia in patients with previous Harrington rod instrumentation (HRI) for correction of idiopathic scoliosis. Patients were identified by the presence of an antepartum anaesthetic consultation for HRI. The anaesthetic record was examined to determine the frequency of epidural catheter insertion and any problems related to this procedure. ⋯ There were no sequelae related to epidural insertion. There were no sequelae related to epidural insertion. We conclude that patients with HRI may be offered epidural anaesthesia for labour and delivery provided that they are informed of the increased risk of complications.
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Case Reports
Computerized axial tomo-epidurographic and radiographic documentation of unilateral epidural analgesia.
A 23-year-old primigravid patient who received epidural analgesia for pain of labour presented with persistent, apparently irremediable, unilateral analgesia. Computerized axial tomo-epidurography demonstrated absence of circumferential spread due to lateral placement of the catheter. Transforaminal escape of contrast medium into the paravertebral area had occurred and anterior and posterior midline partitioning of the epidural space was obvious. All the usual measures to promote contralateral analgesia, except re-insertion of the catheter, had been tried without success.
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Difficult or failed tracheal intubation is an important cause of anaesthetic-related maternal morbidity and mortality. The incidence of failed intubation in parturients is estimated to be as frequent as 1 in 500; that of mortality is unknown, although some 10-13 pregnant women in England, Scotland and Wales die each year because of anaesthetic-related complications. ⋯ Furthermore, adequate assistance, correct use of cricoid pressure, and confirmation of tracheal intubation are fundamental to safe practice. Lastly, should the anaesthetist fail to intubate the patient's trachea, a management protocol is suggested.
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Case Reports
Anaesthetic management of emergency caesarean section followed by pulmonary embolectomy.
This report discusses the anaesthetic management of a patient undergoing emergency Caesarean section followed by an open pulmonary embolectomy with cardiopulmonary bypass. This case was complicated by the major physiological alterations associated with pregnancy and delivery, massive blood loss, cardiac dysrhythmias, hypotension, and cardiac arrest. Both patients, mother and child, made a full recovery.