International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1997
Anatomy of the lumbar epidural region using magnetic resonance imaging: a study of dimensions and a comparison of two postures.
Many techniques used to investigate the epidural region may alter the anatomy. Magnetic resonance imaging (MRI) has been introduced as a non-invasive diagnostic technique. The aim of this study was to investigate the anatomy of the lumbar epidural region using MRI, studying the morphology, the dimensions and the modification that may result from a change of position. ⋯ The circumferentially and metamerically segmented compartments of the epidural space were clearly noted and measured. Ligamenta flava seem to be thinner in younger than in older subjects. This may partly explain a reduced loss of resistance sometimes perceived in obstetric patients.
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Int J Obstet Anesth · Apr 1997
Anesthesia for combined cesarean section and extra-adrenal pheochromocytoma resection: a case report and literature review.
Pheochromocytoma during pregnancy is unusual, with approximately 250 cases now reported in the literature. The current case describes the anesthetic management of a patient with a large extra-adrenal pheochromocytoma who underwent a combined cesarean section and tumor removal in which perioperative hemodynamic control was difficult despite high-dose a-adrenergic blockade. ⋯ Established criteria exist for the adequacy of alpha- and beta-adrebergic blockade for the management of pheochromocytoma in the non-pregnant patient. We discuss how these criteria apply to pregnant patients with pheochromocytoma, and suggest possible modifications to the criteria.
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Int J Obstet Anesth · Apr 1997
Transient seizure: a subtle clue to diagnosis of subarachnoid haemorrhage.
A case is described of a 25-year-old primigravida who sustained a transient seizure following the administration of an epidural bolus of local anaesthetic. She had previously complained of a headache, and 3 days after caesarean section, died from subarachnoid haemorrhage. This case report highlights the difficulty in diagnosing subarachnoid haemorrhage in pregnancy and discusses the anaesthetic complications that may arise in the presence of an undiagnosed aneurysmal rupture. In this case the diagnosis was delayed due to absence of neurological signs, but the transient seizure may have been a clue to an earlier diagnosis.
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Int J Obstet Anesth · Apr 1997
Use of sublingual glyceryl trinitrate as a supplement to volatile inhalational anaesthesia in a case of uterine inversion.
We present a case of uterine inversion in which glyceryl trinitrate was used via the sublingual route, as opposed to the intravenous route, in association with volatile inhalational anaesthesia in order to achieve relaxation of the uterus. A transient, but significant, hypotensive response occurred, which was easily corrected with a colloid infusion and vasopressors. Sublingual glyceryl trinitrate is easily administered, has a fast onset of action and may have a role in situations where rapid relaxation of the uterus is required.