International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2018
Case ReportsPeripartum anaesthetic management of a patient with Brugada syndrome and myoadenylate deaminase deficiency.
Brugada syndrome is a rare electrophysiological cardiac disease which can result in serious arrhythmias and sudden cardiac death. Peripartum management is centred around avoiding arrhythmogenic drugs, including high doses of sodium channel blocking drugs such as bupivacaine. ⋯ There is evidence that myoadenylate deaminase deficiency can predispose patients to developing malignant hyperthermia when exposed to specific anaesthetic agents. We present a case of a pregnant patient with both Brugada syndrome and myoadenylate deaminase deficiency, in which analgesic and general anaesthetic options for each condition presented potentially conflicting dilemmas for the delivery of intrapartum care.
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Int J Obstet Anesth · Aug 2018
Case ReportsSuccessful spinal anaesthesia for caesarean section in a patient with Marfan syndrome complicated by dural ectasia.
Marfan syndrome is a connective tissue disorder that may be complicated during pregnancy by aortic dissection. Caesarean section may be selected to avoid the haemodynamic challenges of vaginal birth. The common occurrence of dural ectasia in patients with Marfan syndrome is known to be associated with failed neuraxial anaesthesia. This report describes the administration of spinal anaesthesia to a woman with Marfan syndrome, and discusses why a hypobaric bupivacaine and opioid mixture, warmed to 37°C and injected intrathecally with the patient seated, produced successful surgical anaesthesia.
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Int J Obstet Anesth · Aug 2018
Intraperitoneal chloroprocaine is a useful adjunct to neuraxial block during cesarean delivery: a case series.
Use of intraperitoneal local anesthetic to treat intraoperative pain during cesarean delivery has not been described previously. The aim of this study was to determine if intraperitoneal chloroprocaine may be useful as an adjunct to neuraxial block in reducing the proportion of patients with severe intraoperative pain that requires conversion to general anesthesia. Intraperitoneal chloroprocaine was administered during cesarean delivery as a potential alternative, when the anesthesiologist considered performing a general anesthetic due to severe intraoperative pain. ⋯ Intraperitoneal chloroprocaine may be useful as part of a multimodal approach to managing intraoperative pain during cesarean delivery.