International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2004
Case ReportsIs continuous spinal analgesia via an epidural catheter appropriate after accidental subarachnoid administration of 15 mL of bupivacaine 0.1% containing fentanyl 2 micrograms/mL?
We report a case of accidental insertion of an epidural catheter into the subarachnoid space and accidental administration of 15 mL of bupivacaine 0.1% with fentanyl 2 micrograms/mL, in the sitting position, during labour. Within 5 min, the patient was unable to move her lower limbs. Although the upper level of the sensory block using ethyl chloride was found to be T5, there was no cardiovascular depression. ⋯ This was conducted under spinal anaesthesia using 2 mL of hyperbaric bupivacaine 0.5% with fentanyl 20 micrograms. A healthy baby was delivered with Apgar scores of 10 and 10, at 1 and 5 min, respectively. There was no postdural puncture headache or any neurological complications.
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Int J Obstet Anesth · Apr 2004
Randomized Controlled Trial Clinical TrialHip-flexed postures do not affect local anaesthetic spread following induction of epidural analgesia for labour.
Hip-flexed postures enlarging the pelvic diameter are used to improve the obstetric course of labour. Although most investigations show that lateral and sitting positions do not affect the spread of epidural analgesia, the effect of recently introduced hip-flexed postures has yet to be confirmed. This prospective randomised study included 93 parturients. ⋯ There was no motor block nor any maternal or fetal side effects. The power of the study (1 - beta) was 93%. We conclude that, for the three hip-flexed postures tested, position does not influence local anaesthetic spread or symmetry of thermo-algesic blockade after induction of obstetric epidural analgesia.
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Int J Obstet Anesth · Apr 2004
Case ReportsAnaesthesia for caesarean section in a patient with syringomyelia and Arnold-Chiari type I malformation.
A 37-year-old primiparous woman with syringomyelia and Arnold-Chiari type I malformation was scheduled to undergo elective caesarean section for a fetus in the breech presentation. Caesarean section was performed under general anaesthesia without complications; all we observed was an exaggerated response to atracurium. ⋯ Syringomyelia is a progressive myelopathy characterised by cystic degeneration within the spinal cord, which causes severe neurological deficits. The anaesthetic management is discussed.
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Int J Obstet Anesth · Apr 2004
Case ReportsAnaesthetic dilemma: spinal anaesthesia in an eclamptic patient with mild thrombocytopenia and an "impossible" airway.
We present our anaesthetic management of a 27-year-old woman with antepartum eclampsia, mild thrombocytopenia, difficult airway and clinical evidence of impending upper airway obstruction. She required urgent delivery by caesarean section, which was conducted uneventfully under spinal anaesthesia. We discuss the management conundrums presented by this case and why we chose spinal anaesthesia over other anaesthetic options.