International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 1999
Randomized Controlled Trial Clinical TrialOxford positioning technique improves haemodynamic stability and predictability of block height of spinal anaesthesia for elective caesarean section.
A novel positioning technique was tested to see whether the unpredictability of block height and haemodynamic instability during spinal anaesthesia for caesarean section could be reduced. In this 'Oxford' position, the woman is placed left lateral with an inflated bag under the shoulder and pillows supporting the head. Following spinal injection the woman is turned to an identical right lateral position. ⋯ Block height was more variable in group S than in group O (f test, P = 0.001). Blood pressure decreased by a greater amount initially: group S women required more ephedrine (15.5 +/- 12.9 versus 9.2 +/- 7.7 mg, t test, P = 0.03). Block height with spinal anaesthesia for caesarean section is more predictable and haemodynamically stable if the Oxford position is used whilst anaesthesia develops.
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A primigravida at 41+ weeks gestation presented with spontaneous rupture of membranes. Labour was induced and later an emergency caesarean section was performed for failure to progress. The patient suffered a per-operative uterine tear and post-partum haemorrhage and required postoperative ventilatory support in the intensive care unit. ⋯ The differential diagnosis, diagnostic difficulties, investigations and clinical management of this case are all discussed. An examination of existing literature highlights some of the focal neurological abnormalities that present with eclampsia and the possible need for more sophisticated neuroradiological investigations in these cases. Finally, it is emphasized that anaesthetists and intensivists need to be aware of atypical and delayed presentations of eclampsia.
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Int J Obstet Anesth · Oct 1999
Anaphylaxis during caesarean section in a patient with undiagnosed placenta accreta: it never rains but it pours!
Published guidelines exist for the management and investigation of suspected anaphylactic reactions associated with anaesthesia. We report a woman who had a life-threatening anaphylactic reaction during caesarean section under spinal anaesthesia, complicated by undiagnosed placenta accreta. We discuss the particular problems of the case and the practical difficulties of testing survivors of anaphylaxis: despite following the recommendations, we have been unable to identify the cause.