International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2017
Neuraxial analgesia in a pregnant woman with Fowler's syndrome and sacral neuromodulation.
We report the anesthetic management of a 16-year-old woman with Fowler's syndrome who became pregnant three years after sacral neuromodulation was initiated for treatment of the condition. Multidisciplinary consensus was to switch off the neurostimulator during pregnancy, and attempt vaginal delivery with a neuraxial block. ⋯ Sacral neuromodulation was restarted uneventfully in the early puerperium and the Fowler's syndrome remains well controlled. The baby continues to develop normally three years after delivery.
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Int J Obstet Anesth · May 2017
Case ReportsParaplegia after accidental continuous subdural analgesia.
Almost all reported cases of unintentional subdural block have described a reversible disorder. We report a patient who developed an incomplete mixed sensory and motor neurological deficit after accidental continuous subdural infusion of 0.1% levobupivacaine given to provide postoperative analgesia after cesarean section. Our report shows that accidental continuous subdural injection can cause permanent neurological sequelae. In the event of suspected compressive neural damage, subdural fluid accumulation, although very rare, should be considered.
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Previous studies have suggested an inverse relationship between obesity and development of post-dural puncture headache following spinal anesthesia. However, few have investigated the relationship between obesity and headaches after accidental dural puncture with an epidural needle. This study explored whether obesity has any association with headaches following an accidental dural puncture. ⋯ Patients with a high body mass index do not appear to be protected from experiencing a post-dural puncture headache after an accidental dural puncture during placement of labor epidural analgesia. Additionally, the intensity of post-dural puncture headache does not vary with body mass index.
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Int J Obstet Anesth · May 2017
Obstetric interventions and maternal morbidity among women who experience severe postpartum hemorrhage during cesarean delivery.
Compared to vaginal delivery, women undergoing cesarean delivery are at increased risk of postpartum hemorrhage. Management approaches may differ between those undergoing prelabor cesarean delivery compared to intrapartum cesarean delivery. We examined surgical interventions, blood component use, and maternal outcomes among those experiencing severe postpartum hemorrhage within the two distinct cesarean delivery cohorts. ⋯ Our findings provide a snapshot of contemporary transfusion and surgical practices for severe postpartum hemorrhage management during cesarean delivery. To determine optimal transfusion and management practices in this setting, large pragmatic studies are needed.
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Int J Obstet Anesth · May 2017
Case ReportsPuerperal ventral epidural hematoma after epidural labor analgesia.
Serious complications in obstetric anesthesia are a rare occurrence. High neuraxial block, respiratory arrest in labor and delivery, and an unrecognized spinal catheter are among the most frequently reported serious complications. A serious complication occurs in approximately 1:3000 obstetric patients. ⋯ We present a case of a puerperal spinal epidural hematoma following epidural labor analgesia. The patient presented with foot drop, which resolved after conservative treatment. We reviewed the epidemiology, clinical manifestations and treatment options for this rare complication.