International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 1996
A case of postoperative anxiety due to low dose droperidol used with patient-controlled analgesia.
A multiparous woman in good psychological health underwent urgent caesarean section in labour. Postoperatively, she was given a patient-controlled analgesia device delivering boluses of diamorphine 0.5 mg and droperidol 0.025 mg. ⋯ After she had received a total of only 0.9 mg droperidol, a syringe containing diamorphine only was substituted and her unease resolved completely. We feel that, although the dramatic extrapyramidal side effects of dopaminergic antiemetics are well known, more subtle manifestations may easily be overlooked.
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Complications of pregnancy may necessitate admission to an Intensive Therapy Unit (ITU). All obstetric patients admitted to ITU were reviewed in order to assess whether these admissions could have been predicted and to determine the place of intensive care compared with high dependency nursing. Case notes of 122 women from a total group of 144 women admitted to an ITU of an inner-city hospital from 1989-1993 were reviewed retrospectively. ⋯ The perinatal mortality rate was 6% and there were three maternal deaths. The need for admission to ITU was unpredictable in two-thirds of the cases. Many of the women evaluated in this review were ineligible for high dependency care and required full ITU facilities, both of which will always be needed to deal with serious complications of pregnancy.
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Int J Obstet Anesth · Oct 1996
The anaesthetic management of a labouring woman with pulmonary arterio-venous malformations.
Epidural analgesia is recommended for many medical conditions in labouring women. We describe a case where it was used successfully in a parturient with multiple pulmonary arterio-venous (a-v) malformations. It has been noted that pregnancy can cause marked deterioration in the condition of such patients. We support the suggestion that pulmonary a-v malformations can be added to the list of conditions for which epidural analgesia should be considered.
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Int J Obstet Anesth · Oct 1996
Untoward incident reporting in obstetric anaesthesia: a 6-month prospective study in Northern Ireland.
The marked reduction in the number of cases related to the provision of anaesthesia, included in the triennial Reports on Confidential Enquiries into Maternal Deaths in the UK, may limit the educational value of such reports for anaesthetists in the future. The collection, analysis and reporting of untoward events related to obstetric anaesthesia may provide an additional method of highlighting areas of clinical practice that could be improved. ⋯ A brief summary of each event is included along with a more detailed description from a sample of the reports. The advantages and disadvantages of untoward incident reporting are discussed, with recommendations made for a future survey.