Subject(s)
Anesthesia, Epidural/instrumentation , Hospitals, General , Equipment Design , Equipment Failure , Filtration , HumansABSTRACT
Spondyloepiphyseal dysplasia congenita is a rare condition with several features of concern to the anaesthetist. The patients are of extremely short stature and the presence of kyphoscoliosis may lead to significant respiratory impairment. Cervical vertebral body changes can result in spinal cord compression and laryngotracheal stenosis may be present. The management of such a patient presenting for elective Caesarean section under epidural anaesthesia is described.
Subject(s)
Anesthesia, Epidural , Anesthesia, Obstetrical , Cesarean Section , Osteochondrodysplasias/congenital , Adult , Blood Pressure/physiology , Female , Humans , Intraoperative Complications/prevention & control , Lidocaine , Pregnancy , Respiration Disorders/prevention & control , Spinal Cord Compression/prevention & controlABSTRACT
A questionnaire survey of current practice at a small cross-section of obstetric units, covering 22% of all United Kingdom deliveries, revealed a marked lack of standard practice regarding requests for coagulation screens on pre-eclamptic patients who require epidural procedures. A retrospective audit was therefore carried out on 434 coagulation screens requested for pre-eclamptic patients in whom epidural analgesia might have been considered. Borderline abnormalities of coagulation were found in only 10 patients (2%). Platelet counts of less than 150 x 10(9)/litre were present in 28% of cases. 'Significant' thrombocytopenia (less than 100 x 10(9)/litre) and all coagulation abnormalities were only encountered in severe pre-eclampsia (diastolic blood pressure of greater than 110 mmHg and proteinuria of + + or greater). Furthermore, coagulation abnormality was always associated with a reduced platelet count (mean, 97 x 10(9)/litre). This study would therefore support anaesthetic practice which restricted any requests for coagulation testing to severe pre-eclamptic patients only. For these patients first line testing could be limited to a platelet count.
Subject(s)
Analgesia, Epidural , Anesthesia, Obstetrical , Blood Coagulation , Pre-Eclampsia/blood , Blood Coagulation/physiology , Blood Coagulation Tests , Female , Humans , Medical Audit , Platelet Count , Pre-Eclampsia/complications , Pregnancy , Retrospective StudiesSubject(s)
Ethics, Medical , Intubation, Intratracheal , Adult , Emergencies , Female , Humans , Incisor/abnormalities , Mandible/abnormalitiesABSTRACT
The demands made upon the Bristol obstetric flying squad over the past 14 years have been analysed. During this period, the number of calls received per year has decreased dramatically. The reasons for this are discussed in the context of current obstetric practice. The management of retained placenta is reviewed. Of importance to anaesthetists is the gross reduction in the number of cases where it is necessary to give anaesthesia 'in the field'. This may lead to complacency and lack of familiarity with the equipment carried by the flying squad.
