International journal of obstetric anesthesia
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Intrathecal anaesthesia, either as a single shot-spinal or as part of a combined spinal-epidural technique, is now widely accepted as the management of choice for caesarean section. It generally produces rapid and predictable anaesthesia, yet occasionally fails for no apparent reason. Four case reports of seemingly inexplicable complete failure of intrathecal anaesthesia are presented, together with a literature review of other cases and possible causes of the failure, which include anatomical abnormality, drug failure and management failure.
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Int J Obstet Anesth · Jul 2007
Case ReportsCombined spinal-epidural analgesia for labor in a patient with Marfan's syndrome.
We report the management of a patient with Marfan's syndrome for labor analgesia and vaginal delivery using a combined spinal-epidural technique. The rapid onset of analgesia for the first stage of labor provided by the intrathecal opioid, combined with the slow and controlled onset of sensory anesthesia and sympathetic block provided by the dilute epidural local anesthetic, may make this technique particularly useful for labor and delivery in patients with Marfan's syndrome.
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Int J Obstet Anesth · Jul 2007
Epidural analgesia for parturients with type 1 von Willebrand disease.
Epidural analgesia is usually contraindicated in von Willebrand disease. However, in type 1, the increased synthesis of von Willebrand factor (vWF) and factor VIII (FVIII:C) during pregnancy can lead to a correction of biological abnormalities and may allow epidural analgesia to be performed for delivery. ⋯ vWF and FVIII:C increased to normal values in all cases at term in these parturients with type 1 von Willebrand disease. Epidural analgesia, when performed for labor, was uncomplicated. However, platelet aggregation tests with PFA-100 unmasked unexpected, persistent abnormalities. The value of this test for clinical decision making remains to be determined by further prospective studies.
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Int J Obstet Anesth · Jul 2007
Case ReportsRapid reversal of critical haemodynamic compromise with nitric oxide in a parturient with amniotic fluid embolism.
We describe a case of amniotic fluid embolism presenting as cardiovascular collapse during labour. After initial resuscitation and emergency caesarean section, the patient was transferred to the intensive care unit with profound hypoxaemia, a high inotropic drug requirement and severe coagulopathy. ⋯ The introduction of nitric oxide at 40 ppm produced a dramatic improvement in her cardiorespiratory status. Mother and baby both survived with no apparent long term sequelae.
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Int J Obstet Anesth · Jul 2007
Case ReportsIntracranial arachnoid cyst: anaesthetic management in pregnancy.
Arachnoid cysts may be intracranial or extracranial in the neuraxis and may present with headache and neurological signs or acutely with rupture and its complications. We report a case of spinal anaesthesia for elective caesarean section in a woman with an intracranial arachnoid cyst of the posterior fossa. We are unaware of any other such case reports published in the English language.