International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1996
Unexpected postpartum seizures associated with post-dural puncture headache treated with caffeine.
This report describes a case of isolated postpartum seizures, in an apparently healthy woman who had suffered an accidental dural puncture during epidural analgesia for labour, and was on caffeine for relief of post-dural puncture headache. Investigation failed to determine the aetiology of the seizures. The possible contribution of dural puncture and caffeine toxicity are discussed.
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Int J Obstet Anesth · Jan 1996
Anaesthetic characteristics and long-term backache after obstetric epidural anaesthesia.
Anaesthetic casenotes of 4700 women who had epidural anaesthesia for deliveries between 1978-1985 were examined to look for associations between various epidural characteristics and subsequently reported long-term backache. The data on long-term backache came from a postal questionnaire sent to the women. ⋯ There were no relationships between long-term backache and the duration of the epidural or various indicators of the extent of motor or sensory block. Within the range of local anaesthetic concentration levels used in this series, the extent of block did not seem to affect backache, but the effect of minimal motor block with corresponding increased mobility, such as is available with low concentration anaesthetics mixed with opiates, merits further study.
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Recently, various authors have noticed and studied the phenomenon of ST segment depression during cesarean section. We have undertaken a review of the various postulated etiologies including venous air emboli, hormonal influences, autonomic nervous system influences tachycardia, postural influences, hypokalemia, hyperventilation, and myocardial ischemia. It appears that ST segment depression during cesarean section is almost certainly a multifactorial phenomenon. ⋯ Venous air emboli, hypokalemia, and hyperventilation probably have a minimal role. The sympatholysis produced by regional anesthesia is of unclear significance. It is important to note the apparent lack of morbidity associated with these changes.