International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 1997
Trans-tracheal ventilation complicated by bilateral pneumothoraces and pneumoperitoneum.
Following induction of general anaesthesia for emergency caesarean section the trachea could not be intubated, and ventilation was established only following two cricothyroidotomies. The baby was delivered unimpaired, and tracheostomy subsequently performed. ⋯ Increasing abdominal distension was relieved by suction to a pelvic drain. Radiographs revealed bilateral pneumothoraces, pneumomediastinum and pneumoperitoneum, which were resolved by intrapleural drainage.
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We wished to determine whether immunosuppression and/or acceleration of human immunodeficiency virus (HIV)-associated disease is related to the mode of anesthesia in the HIV infected parturient. Ninety-six known HIV-infected asymptomatic parturients who delivered between January 1990 and January 1992 at Grady Memorial Hospital were reviewed for pre-delivery health status, mode of anesthesia and peripartum/post-partum complications. Statistics used chi2 analysis. ⋯ Thirty-one of the 96 women had CD4/CD8 T-cell lymphocyte data at second trimester and 24-48 h post partum which showed no worsening of maternal immune status in women receiving regional anesthesia, local anesthesia/intravenous sedation or no anesthesia. We believe that both regional and general anesthesia can be performed safely on the asymptomatic HIV-infected parturient. The choice of anesthesia should be based on the usual obstetric and clinical considerations.