International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2006
Review Case ReportsDoes postdural puncture headache left untreated lead to subdural hematoma? Case report and review of the literature.
The patient was a 39-year-old pregnant woman who was scheduled for cesarean section. Spinal anesthesia was induced using a 26-gauge needle with an atraumatic bevel. Postoperatively, the patient developed cranial subdural hematoma manifesting as severe non-postural headache, associated with right eye tearing, fifth cranial nerve palsy and left hemiparesis. ⋯ Our report reviews the literature on 46 patients who developed a postdural puncture headache complicated by subdural hematoma following spinal or epidural anesthesia. It is possible that postdural puncture headache left untreated may be complicated by the development of subdural hematoma. Patients developing a postdural puncture headache unrelieved by conservative measures, as well as the change from postural to non-postural, require careful follow-up for early diagnosis and management of possible subdural hematoma.
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Int J Obstet Anesth · Jan 2006
Preoperative anxiety and postoperative satisfaction in women undergoing elective caesarean section.
The primary aim was to investigate whether preoperative anxiety in women undergoing elective caesarean section predicts postoperative maternal satisfaction with the process, perceptions of recovery, analgesic use or length of hospital stay. Other factors that might influence postoperative satisfaction were also explored. ⋯ Lower preoperative anxiety is associated with greater maternal satisfaction with elective caesarean section and better recovery. Information provided by anaesthetists and perceived emotional support are also of importance. It may be possible to identify women with high anxiety and facilitate satisfaction and recovery through providing additional supportive input.
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Coronary artery disease is rarely detected during labour and the puerperium. We report the case of a 31-year-old primigravida at 38 weeks of gestation with hypercholesterolaemia and a family history of coronary heart disease, who presented with septal acute myocardial infarction. We decided to perform a caesarean section under general anaesthesia. ⋯ There were no complications during or after surgery. Cardiac ultrasound showed septal hypokinesia with normal systolic function and coronary angiography revealed normal coronary vessels. She remained haemodynamically stable and was discharged from intensive care 48 h later.