International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2013
Case ReportsAnaesthetic management of emergency caesarean section in a parturient with systemic mastocytosis.
Mastocytosis is a rare disorder caused by the proliferation and accumulation of mast cells in various organs. It has a broad variety of clinical manifestations, including cardiovascular collapse. Diverse stimuli trigger the release of vasoactive substances and parturients with systemic mastocytosis are at high risk for precipitating mast cell degranulation. ⋯ This is particularly important in the case of an emergency caesarean section. Resuscitation equipment must be available should life-threatening haemodynamic instability occur during surgery. We report the case of a pregnant woman with systemic mastocytosis who required emergency caesarean section.
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Int J Obstet Anesth · Jul 2013
Outcomes after institution of a new oxytocin infusion protocol during the third stage of labor and immediate postpartum period.
Due to safety concerns when oxytocin is administered in an uncontrolled fashion, and recent dose-response data that indicate oxytocin's effectiveness at doses lower than those traditionally used, we instituted a new protocol for the infusion of oxytocin during the third stage of labor and in the immediate postpartum period. We undertook this study to confirm that this change in practice did not have untoward effects on postpartum hemorrhage rates. ⋯ Adoption of a protocol to infuse oxytocin in a controlled manner at a lower dose than that historically used was not associated with an increased incidence of postpartum hemorrhage.
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Int J Obstet Anesth · Jul 2013
Case ReportsCaesarean section in a parturient with Carpenter syndrome and corrected Tetralogy of Fallot.
Carpenter syndrome is an extremely rare congenital disorder characterized by craniofacial malformations, syndactyly, cardiac defects and obesity. Even after surgical correction of cardiac abnormalities, intrapartum care of a parturient with this condition can be challenging because of progression of residual cardiac defects compounded by the haemodynamic changes of pregnancy. We describe the anaesthetic management for caesarean section of a parturient with Carpenter syndrome and corrected Tetralogy of Fallot. Additional complicating issues included worsening cardiac function, asthma, needle-phobia and osteoarthritis.
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Int J Obstet Anesth · Jul 2013
Case ReportsSpinal anaesthesia for caesarean section in the presence of respiratory failure and spinal metastases from a soft tissue clear cell sarcoma.
Spinal metastases occur in up to 70% of all patients with cancer. However, only 10% are symptomatic. Before considering central neuraxial blockade in patients with malignancy, a history of back pain should be excluded. ⋯ Failure to achieve adequate sensory anaesthesia after central neuraxial blockade or presentation with postoperative paraplegia may indicate the presence of asymptomatic vertebral canal metastases. In this report, the anaesthetic management of a patient with respiratory failure and spinal metastases from a soft tissue sarcoma, requiring caesarean section is described. Sensory anaesthesia extending above a level of imminent cord compression was achieved despite loss of cerebrospinal fluid signal on magnetic resonance imaging.