International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2013
Case ReportsDural ectasia in Marfan's syndrome: magnetic resonance imaging appearances and anaesthetic experience of three deliveries.
Neuraxial anaesthetic techniques are considered useful to minimise haemodynamic stress during labour. In Marfan's syndrome, connective tissue abnormalities not only affect the thoracic aorta but also predispose to dural ectasia. ⋯ We consider that epidural analgesia and anaesthesia are a safe and pragmatic solution for labour and delivery. Lumbo-sacral magnetic resonance imaging at presentation will define dural ectasia and assist in management.
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Int J Obstet Anesth · Nov 2013
The influence of timing on the effectiveness of epidural blood patches in parturients.
Postdural puncture headache is common in parturients following lumbar puncture. If headache is severe and persistent, an epidural blood patch is recommended. In this paper we reviewed the efficacy of epidural blood patches over a 13-year period at two hospitals in Finland with a particular emphasis on its timing. ⋯ Epidural blood patch performed later than 48 h following lumbar puncture or accidental dural puncture is effective in parturients with postdural puncture symptoms. The recurrence rate of symptoms after an initially successful epidural blood patch is high, and therefore patients should be provided with counselling and contact information.
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Int J Obstet Anesth · Nov 2013
Assessing blocks after spinal anaesthesia for elective caesarean section: how different questions affect findings from the same stimulus.
A block to touch to T5 is widely used to indicate an adequate level of block for caesarean section with spinal anaesthesia. However, two studies using a "block to light touch" to T5 as their end-point, had a high requirement for intraoperative analgesia and their results cast doubt on the adequacy of a block to touch to T5. On enquiry, these two papers did not assess complete block to touch, but asked mothers when the touch sensation "was the same as" a control stimulus. The difference between these two assessment methods is unknown. The current study presents prospectively collected sensory block data which included both block to touch and the level when touch was the same as a control stimulus. ⋯ When describing a sensory block, not only is it necessary to indicate the exact stimulus used, but it is important to define the actual question asked of the patient. Clinically, block assessment using the first sharp level and touch same as control are equivalent.