International journal of obstetric anesthesia
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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.
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When investigating different methods of maternal pain relief in labour, neonatal outcome has not always been at the forefront, or else maternal changes, such as haemodynamics, fever, length of labour, need for oxytocin or type of delivery, are taken as surrogates for neonatal outcome. It is essential to examine the actual baby and to appreciate that labour pain itself has adverse consequences for the baby. For systemic analgesia, pethidine has been most extensively studied and compared with neuraxial analgesia. ⋯ The effect on breast feeding has yet to be established, though it is certainly no worse than that of systemic opioid analgesia. Variations in neuraxial technique have little impact on the newborn. Widespread ignorance of the benefit to the newborn of neuraxial labour analgesia in the UK among non-anaesthetists needs to be combated.
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Int J Obstet Anesth · Jan 2011
Letter Case ReportsDangers of rapid oxytocin administration in Eisenmenger's Syndrome.
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Disconnection of the filter from its catheter is an established problem with epidural analgesia. Previously, it has been hypothesised that the screw cap connector is more prone to disconnection than the clamp connector design. The aim of this study was to test which of two mechanisms connecting the epidural catheter and filter was more prone to disconnection. ⋯ We conclude that the Portex connection system is more prone to disconnection and that connection design is an important consideration when trying to minimise catheter disconnection.