International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2004
Case ReportsAnaesthesia for caesarean section in spinal muscular atrophy type III.
We describe the conduct of general anaesthesia for a patient with spinal muscular atrophy Type III (Kugelberg-Welander disease) undergoing elective caesarean section. Apart from a delayed return of skeletal muscle power following non-depolarising neuromuscular blockade the procedure was uneventful. We found no previously published reports of general anaesthesia for caesarean section in this condition in the English language literature. We review the available literature and discuss the potential anaesthetic problems in the management of obstetric patients with this degenerative neuromuscular disorder.
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Int J Obstet Anesth · Jul 2004
Comment Letter Comparative StudyEphedrine or phenylephrine to prevent or treat hypotension during spinal anaesthesia for caesarean section.
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Int J Obstet Anesth · Jul 2004
Case ReportsManagement of a parturient with paroxysmal nocturnal haemoglobinuria.
We present the case of a 30-year-old parturient diagnosed in the first trimester of her first pregnancy as having paroxysmal nocturnal haemoglobinuria. Pancytopenia necessitated regular transfusion of blood products. The risks of infection, haemorrhage and thrombosis, in the presence of severe thrombocytopenia, mild neutropenia and prophylactic anticoagulation, posed management challenges. ⋯ Severe thrombocytopenia proved a contraindication to regional techniques and she required general anaesthesia for evacuation of a retained placenta. The post-partum period was complicated by fever and a requirement for blood products. Management of these problems, of prophylactic anticoagulation and subsequent therapy, are discussed.
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Int J Obstet Anesth · Apr 2004
Comment Letter Case ReportsInadequate spinal anaesthesia with 0.5% Marcain Heavy (Batch 2016).
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Int J Obstet Anesth · Apr 2004
Randomized Controlled Trial Clinical TrialHip-flexed postures do not affect local anaesthetic spread following induction of epidural analgesia for labour.
Hip-flexed postures enlarging the pelvic diameter are used to improve the obstetric course of labour. Although most investigations show that lateral and sitting positions do not affect the spread of epidural analgesia, the effect of recently introduced hip-flexed postures has yet to be confirmed. This prospective randomised study included 93 parturients. ⋯ There was no motor block nor any maternal or fetal side effects. The power of the study (1 - beta) was 93%. We conclude that, for the three hip-flexed postures tested, position does not influence local anaesthetic spread or symmetry of thermo-algesic blockade after induction of obstetric epidural analgesia.