International journal of obstetric anesthesia
-
Int J Obstet Anesth · Nov 2018
Risk factors for post-dural puncture headache following injury of the dural membrane: a root-cause analysis and nested case-control study.
Post-dural puncture headache following trauma to the dural membrane during neuraxial anaesthesia occurs in 0.13-6.5% of pregnant patients. Identifying factors beyond individual performance that contribute to this adverse event is crucial to developing improvement strategies. ⋯ Post-dural puncture headache in this setting is not the result of the individual anaesthetist's characteristics alone. Additional factors including team composition, the presence of obstetrical perinatal pathology, and associated patient's conditions, are also associated with this event. Improvement strategies should consider all these factors.
-
Int J Obstet Anesth · Aug 2018
Randomized Controlled Trial Comparative StudyA randomized trial comparing surgeon-administered intraoperative transversus abdominis plane block with anesthesiologist-administered transcutaneous block.
Injection of local anesthetic into the transversus abdominis plane (TAP block) decreases systemic morphine requirements after abdominal surgery. We compared intraoperative surgeon-administered TAP block (surgical TAP) to anesthesiologist-administered transcutaneous ultrasound-guided TAP block (conventional TAP) for post-cesarean analgesia. We hypothesized that surgical TAP blocks would take less time to perform than conventional TAP blocks. ⋯ Surgical TAP blocks are feasible and less time consuming than conventional TAP blocks, while providing comparable analgesia after cesarean delivery.
-
Heterotopic heart transplants were introduced in 1974. The technique allows the patient's native heart to be preserved in situ, alongside the transplanted heterotopic donor heart. We present the case of a nulliparous woman who underwent heterotopic heart transplant in infancy, and subsequent explantation of the donor heart eleven years later, when her native heart function recovered. ⋯ At 35 weeks-of-gestation she was admitted to hospital with preeclampsia. After blood pressure control and steroid administration, a category 3 caesarean delivery under spinal anaesthesia was performed. To our knowledge this is the first case report describing pregnancy in a patient with a removed heterotopic heart transplant.