International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2005
Case ReportsEpidural anesthesia in a parturient with neurofibromatosis type 2 undergoing cesarean section.
Neurofibromatosis type 2 (NF2) is a rare condition only recently recognized. We present a case describing successful regional analgesia in a parturient with NF2 after thorough imaging revealed no tumors within the epidural space. The presence of tumors within the spinal cord and nerve roots and their potential enlargement during pregnancy make routine neuraxial anesthesia hazardous in patients with NF2. Lumbosacral imaging before performing regional anesthesia is recommended.
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Int J Obstet Anesth · Oct 2005
Case ReportsEpidural catheter-induced paresthesia accompanied by changes in skin color and temperature in an obstetric patient.
Placement of epidural catheters for labor analgesia is a common procedure that has become more popular in recent years. However, this procedure can often cause paresthesia, which is typically characterized as a transient and intense burning pain radiating to the hip or leg. In this case report, we describe a patient who had persistent paresthesia in her right foot caused by an indwelling epidural catheter, which was successfully relieved following a partial withdrawal of the epidural catheter. ⋯ This cold and pale skin on the right foot represents a localized sympathetic discharge associated with the epidural-induced paresthesia, a phenomenon that has not previously been described. Based on the location of the paresthesia and the pathway of the sympathetic nerve fibers, it is unlikely that this localized sympathetic discharge was due to a direct irritation of the preganglionic sympathetic fibers in the spinal nerve roots by the epidural catheter and thus, a spinal reflex was probably involved. This phenomenon provided us with additional clinical evidence of nerve root irritation, which prompted us to act quickly, and resulted in a favorable outcome.
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Int J Obstet Anesth · Oct 2005
Case ReportsA parturient with neurofibromatosis type 2: anesthetic and obstetric considerations for delivery.
Neurofibromatosis type 2 is an extremely rare form of neurofibromatosis characterized by central nervous system involvement with bilateral vestibular schwannomas and spinal tumors. Anesthetic management of a parturient with neurofibromatosis type 2 has not been fully reported, and the condition is challenging to obstetric anesthesiologists due to the presence of intracranial and intraspinal canal neurofibromas. ⋯ Because of central neuraxial involvement, regional anesthesia was avoided, and the patient delivered by cesarean section under general anesthesia. The importance of pre-operative diagnosis and multidisciplinary management for neurofibromatosis type 2 is emphasized and anesthetic and obstetric considerations for delivery are presented.
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Int J Obstet Anesth · Oct 2005
Acid aspiration prophylaxis in labour: a survey of UK obstetric units.
The risk of acid aspiration is still a major concern in pregnant patients. In view of the increasing numbers of drugs available to decrease gastric acid production, it seemed timely to reassess acid aspiration prophylaxis policies in the UK. ⋯ Compared to previous surveys of UK practice there has been an overall increase in the use of acid aspiration prophylaxis.