International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2013
Case ReportsRecurrent psychogenic paresis after dural puncture in a parturient.
We describe the case of a 29-year-old parturient who, after undergoing elective cesarean delivery, displayed symptoms of lower extremity weakness and sensory deficit. Her past medical history was significant for asymptomatic Arnold Chiari Type I malformation and asthma. She had received spinal anesthesia that failed to achieve an adequate surgical level requiring conversion to general anesthesia. ⋯ At 27 weeks of gestation, she had similar lower extremity symptoms after a lumbar puncture, performed to exclude meningitis for severe headache symptoms. Psychogenic paresis is not commonly reported in the medical literature and we found no reports of psychogenic paresis after spinal anesthesia in a parturient or recurrent psychogenic paresis. We review the various risk factors, etiology, neurological signs and symptoms, types, therapy and future management of a patient with recurrent conversion disorder.
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Int J Obstet Anesth · Apr 2013
Case ReportsEpidural injection of hydroxyethyl starch in the management of postdural puncture headache.
Epidural blood patch is the standard treatment for postdural puncture headache when symptomatic therapy is ineffective. We report the cases of two patients who received an epidural injection of hydroxyethyl starch when an epidural blood patch was contraindicated; one due to Streptococcus agalactiae bacteraemia and one due to acute leukaemia. Relief of headache was achieved in both patients with no adverse effects. The use of an epidural hydroxyethyl starch injection may be a suitable alternative for treatment of postdural puncture headache if epidural blood patch is contraindicated.
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Int J Obstet Anesth · Apr 2013
A qualitative analysis of parturients' perspectives on neuraxial labor analgesia.
The decision to use, or not use, neuraxial analgesia is complex and likely multi-factorial. The objectives of this study were to understand parturients' concerns about neuraxial analgesia, and the reasons for not anticipating the use of neuraxial analgesia using qualitative methodology. ⋯ Many women who anticipate not using neuraxial analgesia may be basing their decision on an inaccurate understanding of the risks of the procedure. Improved patient education and counseling that target specific areas of concern may address these misunderstandings.
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Int J Obstet Anesth · Apr 2013
Does body mass index influence the degree of pelvic tilt produced by a Crawford wedge?
A pelvic tilt of 15° is standard practice when positioning a woman for caesarean section, and is commonly produced by tilting the operating table or placing a wedge under the right hip. This study investigated whether body mass index affects the degree of pelvic tilt produced when a wedge is used. ⋯ Variability in pelvic tilt increased with body mass index and was greatest with a booking body mass index >35kg/m(2).
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Int J Obstet Anesth · Apr 2013
Case ReportsAn ex utero intrapartum treatment procedure in a patient with a family history of malignant hyperthermia.
In the EXIT (ex utero intrapartum treatment) procedure, after uterine incision, uterine relaxation is maintained to prevent placental separation and the fetus is supported via the placenta until the airway is successfully established. The traditional method to maintain uterine relaxation is with the use of high-dose potent inhaled anesthetics during general anesthesia. ⋯ The history of malignant hyperthermia precluded the use of potent inhaled anesthetics and an alternate plan using propofol and remifentanil infusions for anesthesia and nitroglycerin 16 μg/kg/min for uterine relaxation allowed for good surgical conditions. The presence of malignant hyperthermia required an alternate plan and close collaboration in order to ensure good patient outcome.