International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1998
Anaesthetic management of a parturient with severe congenital factor XI deficiency undergoing caesarean section for triplet pregnancy.
The report describes the anaesthetic management of a Jewish patient of Ashkenazi descent with severe factor XI deficiency complicated by thrombocytopenia for caesarean section for triplets at the 35th week of gestation. Perioperative management consisted of sustained replacement therapy with fresh frozen plasma and platelets until the sixth postoperative day. General anaesthesia was used for the procedure. No other maternal or neonatal complications occurred.
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During pregnancy, the thyroid undergoes several changes including altered function and gland enlargement. We describe the management of a 38-week pregnant woman presenting with cough and increasing breathlessness. She gave a 5-year history of asthma which initially obscured the final diagnosis of upper-airway obstruction secondary to tracheal compression by a large retrosternal goitre. ⋯ Delivery by caesarean section was carried out under epidural anaesthesia, following which her symptoms rapidly resolved. A subtotal thyroidectomy was performed 4 weeks later under general anaesthesia, again without incident. We outline the normal physiological changes that occur to the thyroid gland during pregnancy and also highlight the value of the flow volume loop in the evaluation of airway obstruction.
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Int J Obstet Anesth · Jan 1998
Pregnancy and delivery in a patient with recent peripartum cardiomyopathy.
We present a case of successful pregnancy and delivery in a patient with peripartum cardiomyopathy who conceived only 3 months after a vaginal delivery complicated by peripartum cardiomyopathy. Following the onset of labor, an arterial pressure catheter and pulmonary artery catheter were placed. ⋯ After a few hours of labor, the fetal heart rate tracing revealed repetitive variable decelerations, and a decision was made to proceed with operative delivery. The mother's hemodynamic changes are presented, and the specifics of the anesthetic care are outlined.
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Int J Obstet Anesth · Jan 1998
Mivacurium for caesarean section in hypertensive parturients receiving magnesium sulphate therapy.
The interaction between mivacurium and magnesium sulphate was investigated in a group of parturients undergoing caesarean section under general anaesthesia. Thirty parturients were studied; 10 normotensive controls (group NT), 10 hypertensive controls (group HT) and 10 hypertensives who received magnesium sulphate (group HTM). At induction group HT received 30 microg/kg of alfentanil and group HTM 10 microg/kg of alfentanil and 30 or 60 mg/kg of magnesium sulphate. ⋯ Time to maximal recovery, and time from 25-75% of maximal recovery from mivacurium, were significantly prolonged in group HTM (60.9 +/- 15.3 min and 16.8 +/- 5.6 min) compared with group HT (34.9 +/- 7.6 min and 7.6 +/- 3.6 min) and group NT (37.4 +/- 14.4 min and 8.5 +/- 3.4 min) (P < 0.01). Time to 25% recovery was prolonged in group HTM (35.1 +/- 7.4 min) compared with the other two groups (HT: 21.6 +/- 6.4 min and NT: 22.8 +/- 10.2 min) (P < 0.01). Whilst the duration of action of mivacurium, determined by electromyography, is prolonged by subtherapeutic serum magnesium concentrations, of the available non-depolarizing relaxants mivacurium would seem to be most appropriate for caesarean section.
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Int J Obstet Anesth · Jan 1998
Convulsions in a healthy parturient due to intrapartum water intoxication.
Water intoxication during pregnancy is an uncommon event, usually associated with iatrogenic fluid overload, the prolonged administration of high doses of oxytocin or psychiatric disorder. This case report describes water intoxication presenting as the sudden onset of grand mal convulsions in the immediate postpartum period, after a normal delivery in a healthy parturient. The most likely explanation was an excessive voluntary ingestion of large quantities of water and hypotonic fluids during labour.