International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 1997
A survey of facilities for high risk women in consultant obstetric units.
Reports on Confidential Enquiries into Maternal Deaths and the Obstetric Anaesthetists' Association have made recommendations about the provision of staff and facilities in consultant obstetric units. We have carried out a postal survey of all units in the UK concerning provision of recovery facilities, high dependency and intensive care, and anaesthetic staffing. ⋯ In particular, only 62% had a designated and staffed recovery area, only 41% had specific obstetric high dependency beds and there were a number of units with no consultant anaesthetic sessions or trained anaesthetic assistants available around the clock. Despite the practical and financial difficulties in achieving recommended standards, it should be noted that purchasers of health care have been encouraged to ensure that the recommendations are implemented.
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Int J Obstet Anesth · Jul 1997
An unusual complication following combined spinal-epidural anaesthesia for caesarean section.
The combined spinal-epidural technique is widely used in obstetric anaesthetic practice. Epidural catheter migration through a dural hole is a theoretical but rarely described complication. We report a case of acute and life-threatening respiratory depression following administration of diamorphine through an epidural catheter after a single space combined spinal-epidural technique for caesarean section. We believe this complication occurred as a result of catheter migration through a dural hole into the subdural space and rupture of the thin arachnoid layer causing massive subarachnoid blockade.
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Int J Obstet Anesth · Jul 1997
Bilateral trigeminal nerve palsy during an extensive lumbar epidural block.
A rare case of trigeminal nerve blockade arising in the course of obstetric lumbar epidural anaesthesia is described. There was extensive bilateral spread of nerve-block up to the C4 level with respiratory distress after top-up for caesarean section, and subsequent epidurography revealed high epidural spread of contrast. The mechanism of the trigeminal nerve palsy was the source of some controversy, particularly as to whether intracranial spread of local anaesthetic had occurred, possibly following accidental subdural or subarachnoid injection.