International journal of obstetric anesthesia
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This is a retrospective record of the analgesic management during labour of 16 patients with spina bifida seen at Leicester Royal Infirmary Maternity Hospital between March 1994 and February 1996. The information highlights the potential difficulties in providing epidural analgesia for this patient group, and demonstrates how an antenatal pre-anaesthetic clinic can help to optimize pain management by providing the opportunity to formulate a realistic analgesic plan, which can be documented in the notes.
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Int J Obstet Anesth · Apr 1998
Labour analgesia in a patient with carnitine palmityl transferase deficiency and idiopathic thrombocytopenic purpura.
We report a case of a woman with carnitine palmityl deficiency (CPT) and idiopathic thrombocytopenic purpura, presenting in active labour at 38 weeks gestation. We discuss different anaesthetic factors involved with both diseases, and we propose an optimal management of such cases. Neuraxial analgesia with minimal motor blockade is indicated in early labour because it is necessary to alleviate stress in order to avoid rhabdomyolisis associated with CPT deficiency. Neuraxial analgesia is also needed because the theoretical risk of performing a caesarean section is higher than in a normal population, first because labour must be kept as short as possible and secondly because the possible thrombocytopenic in the baby precludes the use of instrumental delivery.
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Int J Obstet Anesth · Apr 1998
Severe urticaria and pregnancy: use of the Internet to aid management.
A case of severe urticaria complicating pregnancy is described. Advice was sought and received from experts in the condition, using the Internet to exchange information. Epsilon-aminocaproic acid (EACA) was used with no apparent adverse effects. This case report highlights some of the problems of management of thi rare condition in pregnancy and obstetric anaesthesia, and the potential benefit of the Internet and its user groups.
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Int J Obstet Anesth · Apr 1998
Complete recovery after near-fatal venous air embolism during cesarean section.
During replacement to the abdomen of the exteriorized uterus at cesarean section under epidural block, a previously healthy woman developed cardiorespiratory arrest. Tracheal intubation revealed low end-tidal carbon dioxide concentration suggesting embolization. Resuscitative efforts were successful. Uterine exteriorization - as well as the Trendelenburg position - significantly increase the risk of air embolization so that routine use of appropriate monitors is indicated to facilitate early diagnosis.