International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1997
Low dose epidural bupivacaine/fentanyl infusion does not mask uterine rupture.
A patient is described in whom the symptoms and signs of uterine rupture were not masked by combined spinal epidural analgesia with an epidural infusion of 0.1% bupivacaine and 1.5 microg ml(-l) fentanyl. Early recognition of the dehiscence of a previous caesarean section scar resulted in an excellent neonatal and maternal outcome.
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Int J Obstet Anesth · Jan 1997
Total intravenous anaesthesia for caesarean section in a patient with Marfan's syndrome.
The case is described of a pregnant patient with Marfan's syndrome scheduled at 39 weeks' gestation for elective caesarean section carried out for the first time by total intravenous anaesthesia (TIVA) with continuous intravenous (i.v.) infusion of propofol. The diagnosis was based on a positive family history, classic phenotype, scoliosis, arachnodactyly, high narrow palate, hyperextensible joints, ectopia lentis and mitral valve prolapse, with a secondary low mitral insufficiency. Maternal and fetal surveillance did not detect complications during the course of pregnancy. ⋯ Apgar scores were 9 at 1 and 5 min. The post-delivery course was unremarkable and post partum echocardiography showed no changes from before caesarean section. The cardiovascular problems of Marfan's syndrome, the risk of haemodynamic changes associated with pregnancy and delivery, its anaesthetic implications and the possible advantages of TIVA with continuous i.v. infusion of propofol in the anaesthetic management of caesarean section in patients with this disease are discussed.
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Int J Obstet Anesth · Jan 1997
Hamman's syndrome: pneumomediastinum and subcutaneous emphysema occurring in labour.
The syndrome of pneumomediastinum and subcutaneous emphysema is a rare and interesting complication of labour. The first case was recorded in 1784 and since that time some 200 other cases have been published. However, very little has appeared in the anaesthetic journals. ⋯ Chest X-ray showed a pneumomediastinum. It is postulated that the use of nitrous oxide may have exacerbated and so highlighted a pre-existing pneumomediastinum since there were no other features of the anaesthetic to account for this pathology. The pathophysiology, diagnosis and management of this condition are discussed together with a historical literature review.