International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2018
Myocardial tissue characterisation and detection of myocardial oedema by cardiovascular magnetic resonance in women with pre-eclampsia: a pilot study.
Pre-eclampsia is characterised by increased left ventricular wall thickness on transthoracic echocardiography (TTE). This is assumed to be myocardial hypertrophy, however TTE cannot determine myocardial structure which may be muscle, oedema or fibrosis. Given the high incidence of peripheral oedema in pre-eclampsia, we hypothesised that increased thickness could represent oedema. Cardiovascular magnetic resonance (CMR) characterises myocardial tissue, differentiating between hypertrophy, oedema and fibrosis. This pilot study was designed to characterise myocardial composition using CMR in pregnant women (healthy or with pre-eclampsia) and to compare cardiac output and left ventricular mass using TTE and CMR. ⋯ Cardiovascular magnetic resonance was used to characterise the myocardial tissue in women with pre-eclampsia. Data suggest that some women with pre-eclampsia have myocardial oedema rather than hypertrophy.
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Int J Obstet Anesth · Nov 2018
Case ReportsCombined spinal-epidural anesthesia with non-invasive ventilation during cesarean delivery of a woman with a recent diagnosis of amyotrophic lateral sclerosis.
Amyotrophic lateral sclerosis is the most common neurodegenerative upper and lower motor neuron disease in adults but is not common in women of child-bearing age. We present a case of a pregnant woman who was diagnosed with amyotrophic lateral sclerosis and developed respiratory distress at 32 weeks-of-gestation. She underwent a cesarean delivery under combined spinal-epidural anesthesia with non-invasive ventilation. This resulted in a successful outcome for both the mother and the baby.
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Int J Obstet Anesth · Nov 2018
Case ReportsManagement of anesthesia for cesarean delivery in a patient with an unruptured intracranial aneurysm.
Headaches are a common symptom during pregnancy. The thunderclap headache is a sudden onset headache reaching maximal intensity within seconds to minutes. It is typically a subarachnoid hemorrhage caused by rupture of an intracranial aneurysm or arteriovenous malformation. ⋯ The relationship between the mode of delivery and incidence of rupture is not well defined. In this case report, we discuss the anesthetic management for cesarean delivery of a parturient with an unruptured aneurysm, located on the left ophthalmic-internal carotid artery. The delivery options and anesthetic technique used are presented, together with a review of published literature.
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Int J Obstet Anesth · Nov 2018
A survey of practice of rapid sequence induction for caesarean section in England.
In view of newer techniques of preoxygenation and laryngoscopy and recent obstetric guidelines concerning the management of difficult intubation, we aimed to evaluate the current practice of rapid sequence induction for caesarean section in England. ⋯ Our survey demonstrated the significant variation in the practice of rapid sequence induction for caesarean section in obstetrics in the United Kingdom.