International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2011
Case ReportsAnesthetic management of a pregnant woman with Gorham-Stout disease.
Gorham-Stout disease is a rare disorder of bone loss and proliferation of lymphatic and vascular tissue (lymphangiomatosis). A 30-year-old nulliparous woman with Gorham-Stout disease presented at 8weeks of gestation with a fused cervical spine. At 31weeks she developed basilar invagination and neurological symptoms that were managed with a neck brace. ⋯ A semi-urgent cesarean delivery under spinal anesthetic proceeded uneventfully, with an otolaryngologist present in case a surgical airway was required. Mother and baby were discharged home after three days. Maternal postpartum recovery was complicated by episodes of respiratory compromise and critical bone loss in the cervical spine, necessitating further surgical reinforcement.
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Int J Obstet Anesth · Jan 2011
ReviewThe role of lipid emulsion during advanced cardiac life support for local anesthetic toxicity.
Lipid emulsion has recently emerged as a potential antidote for local anesthetic systemic toxicity. This review examines the literature and guidelines for administration of lipid emulsion in the setting of advanced cardiac life support.
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Int J Obstet Anesth · Jan 2011
Randomized Controlled Trial Comparative StudyLow-dose ketamine with multimodal postcesarean delivery analgesia: a randomized controlled trial.
Ketamine at subanesthetic doses has analgesic properties that have been shown to reduce postoperative pain and morphine consumption. We hypothesized that intravenous ketamine 10mg administered during spinal anesthesia for cesarean delivery, in addition to intrathecal morphine and intravenous ketorolac, would decrease the incidence of breakthrough pain and need for supplemental postoperative analgesia. ⋯ We found no additional postoperative analgesic benefit of low-dose ketamine during cesarean delivery in patients who received intrathecal morphine and intravenous ketorolac. Subjects who received ketamine reported lower pain scores 2weeks postpartum.
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Int J Obstet Anesth · Jan 2011
Case ReportsMultiple complications following the use of prophylactic internal iliac artery balloon catheterisation in a patient with placenta percreta.
The incidence of placenta praevia/accreta is increasing, placing women at significant risk of postpartum haemorrhage with associated morbidity and mortality. National guidelines recommend prophylactic placement of internal iliac artery balloon occlusion catheters for women with abnormal placentation. ⋯ She developed bilateral pseudoaneurysms, unilateral arterial rupture and compromised vascular supply to her right leg secondary to thrombus formation, and suffered massive haemorrhage, both despite and as a result of intervention. This is the first case report of multiple complications in an obstetric patient after temporary internal iliac balloon occlusion in an elective setting.
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Int J Obstet Anesth · Jan 2011
Case ReportsAnesthetic management of a parturient with type III Klippel-Feil syndrome.
Klippel-Feil syndrome is believed to occur from failure of normal segmentation of cervical somites during gestation. We present the case of a 38-year-old primiparous woman with type III Klippel-Feil syndrome for elective cesarean delivery. Our patient had a short webbed neck, short stature, limited neck flexion and extension, and thoraco-lumbar abnormalities. ⋯ We planned a combined spinal-epidural technique; however, only the epidural technique was obtained. Cesarean delivery was commenced with favorable maternal and fetal outcomes. Post-operative pain management was provided with intravenous morphine patient-controlled analgesia.