International journal of obstetric anesthesia
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Headache following epidural analgesia is a common cause of complaint, but accidental dural puncture rates vary among hospitals and with techniques. We were therefore interested to discover the extent of audit of dural puncture, the dural puncture rates in those UK centres that kept reliable records, and the techniques they used for detecting the epidural space. Consultants in charge of anaesthetic services to all 257 obstetric units in the UK were sent a questionnaire requesting numbers of obstetric epidurals, techniques used to detect the epidural space and the numbers of accidental dural punctures in the years 1991-1995. ⋯ Most respondents did not record the loss of resistance technique used but among those who did, the dural puncture rate using mainly saline was 0.69% and using mainly air was 1.11% (P<0.001). Since accurate patient information is crucial for informed consent, audit needs to be improved in many centres. Though the accidental dural puncture rate may be under-reported in this survey, our data are in agreement with other findings that loss of resistance to saline is safer than loss of resistance to air.
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Int J Obstet Anesth · Oct 1998
Anaesthesia for caesarean section in a patient with systemic amyloidosis secondary to familial Mediterranean fever.
The anaesthetic management of a 33-year-old primigravid woman at 29 + 5 weeks' gestation with familial Mediterranean fever (FMF), secondary amyloidosis, renal allograft with deteriorating renal function and cardiac impairment for emergency caesarean section is described. Pathophysiology and management options are discussed. Cautious induction of epidural anaesthesia together with continuous invasive monitoring produced a good outcome for mother and baby.
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On the first post-partum day, 324 mothers completed a questionnaire designed to assess maternal perception of delivery room experience. Antenatal pain expectation, actual pain severity, analgesia received, as well as maternal satisfaction and choice of analgesia for future deliveries were recorded. Forty-five percent of primiparae and 36% of multiparae reported that they anticipated suffering extreme pain during delivery. ⋯ Among mothers who received continuous epidural analgesia 70% described their experience as good or excellent and 65.8% indicated that they would request similar pain relief in the future. Despite advances in obstetric analgesia, women anticipate and actually experience severe pain during childbirth. However, due to psychological and cultural factors, as well as possible post-partum euphoria, satisfaction with the delivery room experience is high.
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We report the anaesthetic management of a primiparous patient presenting in late pregnancy with rapidly progressive bitemporal hemianopia due to a pituitary mass caused by autoimmune hypophysitis. Caesarean section was complicated by post-partum haemorrhage. Anaesthesia is discussed together with a review of the literature on lymphocytic hypophysitis.
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Int J Obstet Anesth · Oct 1998
Acute airway obstruction during spinal anaesthesia for caesarean section.
A 30-year-old primiparous Caucasian woman with known placenta praevia required an emergency caesarean section for a mild antepartum haemorrhage at the onset of spontaneous term labour. Following intravenous prehydration with 500 ml gelatin colloid (Haemaccel trade mark ), spinal anaesthesia was induced in the sitting position with 2.6 ml of 0.5% hyperbaric bupivacaine (13 mg). The patient was then placed in the recumbent position with left lateral tilt, whereupon she suddenly became dyspnoeic. ⋯ Since parturients have a higher incidence of difficult airway management than the general population, anaphylactoid reactions presenting as angioneurotic oedema pose a particular challenge for the anaesthetist. The lower incidence of allergy associated with hydroxyethyl starch (Hetastarch) may make it a more appropriate choice of colloid in this setting. However, the balance of evidence now suggests that vasopressors, particularly ephedrine, are superior to fluids for maintenance of blood pressure during regional anaesthesia for caesarean section.