International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2011
Case ReportsAnaesthesia for caesarean section in a patient with Sturge-Weber syndrome following acute neurological deterioration.
Sturge-Weber syndrome consists of facial capillary malformation (port-wine stain) and abnormal blood vessels in the brain or eye. Seizures, developmental delay and intracranial and airway angiomata are principal concerns. We report a 28-year-old primiparous woman at 41 weeks of gestation with Sturge-Weber syndrome who developed unilateral weakness, aphasia, blurred vision and confusion. ⋯ Despite the possibility of raised intracranial pressure and precipitation of cerebral herniation, a lumbar epidural block was administered but failed. A subarachnoid block was successfully performed and a healthy infant delivered. The choice of anaesthesia was strongly influenced by detailed radiological investigations and multidisciplinary participation.
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Int J Obstet Anesth · Jul 2011
Case ReportsFailure of neuraxial anaesthesia in a patient with Velocardiofacial syndrome.
Velocardiofacial or 22q11 deletion syndrome is a genetic condition caused by deletion 22q11, the deletion of a small segment of the long arm of chromosome 22. To our knowledge this is the first case report of a woman with Velocardiofacial syndrome presenting in late pregnancy for caesarean delivery. ⋯ In addition examination revealed micrognathia and scoliosis. Neuraxial anaesthesia was unsuccessful and subsequent conversion to general anaesthesia was necessary despite concerns regarding her facial abnormalities, pulmonary regurgitation and mild intellectual impairment.
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Int J Obstet Anesth · Jul 2011
Randomized Controlled Trial Comparative StudyPostoperative analgesia with tramadol and indomethacin for diagnostic curettage and early termination of pregnancy.
The postoperative analgesic effects of rectal indomethacin and tramadol were compared in patients undergoing elective termination of first trimester pregnancy and diagnostic dilatation and curettage. ⋯ When compared to indomethacin 100 mg, preoperative administration of tramadol 100 mg provides superior postoperative analgesia with minimal adverse effects.
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Int J Obstet Anesth · Jul 2011
Case ReportsLower extremity radicular pain after prophylactic intrathecal saline injection through a subarachnoid catheter following accidental dural puncture.
We describe a case in which severe lower extremity radicular pain occurred after administration of 0.9% saline into the subarachnoid space through a catheter that had been left for 20 h following inadvertent dural puncture in an obstetric patient. A 42-year-old (G8P7) woman was admitted for repeat cesarean delivery. Accidental dural puncture occurred during epidural placement. ⋯ Subsequently, the patient developed a postdural puncture headache that persisted for three days. The patient's radiculitis and paresthesia likely resulted from an acute increase in intrathecal pressure after saline administration or from direct catheter irritation. Although both intrathecal saline administration and subarachnoid catheter placement have been previously proposed as ways to prevent postdural puncture headache, their efficacy remains controversial, and we advise caution with these techniques.