International journal of obstetric anesthesia
-
Int J Obstet Anesth · Feb 2016
ReviewIntracranial subdural haematoma following neuraxial anaesthesia in the obstetric population: a literature review with analysis of 56 reported cases.
Intracranial subdural haematoma is a rare but serious complication of neuraxial anaesthesia. With early diagnosis and treatment, severe neurological sequelae can be avoided. A literature search of intracranial subdural haematoma following neuraxial anaesthesia in obstetric patients was performed. Based on the findings, a flow chart on how to assess postpartum headache following a neuraxial procedure is proposed. ⋯ Intracranial subdural haematoma following neuraxial anaesthesia in obstetric patients is rare but serious complications may result. Vigilance is required whenever a headache becomes non-postural, prolonged and/or whenever focal neurological signs occur.
-
Int J Obstet Anesth · Feb 2016
The extension of epidural blockade for emergency caesarean section: a survey of Scandinavian practice.
Little is known about drugs and safety precautions used during epidural top-ups for emergency caesarean section in Scandinavia. We surveyed Scandinavian practice of epidural top-up regimens for emergency caesarean sections. ⋯ Epidural top-ups for emergency caesarean section in Scandinavia are used frequently but normally performed in the operating theatre. Drugs used differ greatly between countries and departments although top-up volumes appear similar. During transport, available equipment and drugs were limited. Best practice guidelines and national guidelines present little information on epidural top-ups that could explain the variation found.
-
Int J Obstet Anesth · Feb 2016
Observational StudyPreferences of Jehovah's Witnesses regarding haematological supports in an obstetric setting: experience of a single university teaching hospital.
Jehovah's Witnesses have been shown to be at increased risk of mortality and morbidity as a consequence of obstetric haemorrhage and refusal of blood products. Since 2004, however, Jehovah's Witnesses have been allowed to accept minor fractions of blood at their own discretion. We sought to determine the preferences of pregnant Jehovah's Witnesses regarding haematological supports since this policy change. ⋯ The spectrum of acceptance of blood products is wide ranging within our obstetric Jehovah's Witnesses population. Recombinant factors are not universally acceptable despite their identification as non-blood products. A multidisciplinary approach with individualized consent is recommended.
-
Int J Obstet Anesth · Feb 2016
Case ReportsChronic myeloid leukemia in pregnancy: an absolute contraindication to neuraxial anesthesia?
Chronic myeloid leukemia is rare in pregnancy with an estimated incidence of 1:75000. It is a genetic myeloproliferative disorder marked by increased and unregulated growth of myeloid cells in the bone marrow. The terminal phase of chronic myeloid leukemia may develop into a blast crisis, defined as >30% myeloblasts in the circulation. ⋯ We describe the anesthetic management of a patient with chronic myeloid leukemia and blast cells in the circulation who required cesarean delivery. After considering the potential anesthetic risks and benefits, general anesthesia was chosen. Although an iatrogenic central nervous system blast crisis is extremely rare, the high morbidity and mortality associated with such an event should be considered when formulating an anesthetic plan.