ABSTRACT
There are increasing numbers of combined heart-lung transplants being carried out in young people for end-stage pulmonary disease. There have-to-date been few reports of pregnancy in heart-lung transplant recipients. We report on the successful outcome of three pregnancies involving two patients following heart-lung transplantation. The importance of an interdisciplinary approach to the care of such patients throughout pregnancy is clear. The deliveries were carried out by caesarean section under regional anaesthesia and the discussion focuses on the choice of anaesthesia along with the problems these patients present to the anaesthetist. Regional anaesthesia appears to be a safe technique in these patients. However, it is important to appreciate that the response to vasoactive drugs may be unpredictable and that intravenous fluid should be administered carefully as they are at risk of fluid overload and pulmonary oedema.
ABSTRACT
The pain relief provided by regular intramuscular diclofenac and on demand intramuscular papaveretum was compared over a 48 h postoperative period in 114 patients undergoing total hip replacement. The study was of a randomised, single-blind, between-group design. Patients were assessed by a surgeon, physiotherapist and nursing staff. Diclofenac was more effective than papaveretum in pain control (P less than 0.001), wound tenderness (P less than 0.01), awareness (P less than 0.001) and mobilisation (P less than 0.01). Wound drainage (P greater than 0.05) and wound oedema (P greater than 0.05) were not significantly different in the two treatments. Gastrointestinal complications were encountered in both groups; two patients on diclofenac had to be withdrawn because of them. The use of diclofenac given as a postoperative analgesic is rewarding, particularly in patients undergoing musculoskeletal procedures. Patients will be more comfortable and will mobilise better during their whole postoperative course.
Subject(s)
Diclofenac/therapeutic use , Opium/therapeutic use , Pain, Postoperative/drug therapy , Aged , Clinical Trials as Topic , Female , Hip Prosthesis , Humans , Male , Middle Aged , Random AllocationABSTRACT
The management of childbirth, including epidural anaesthesia for Caesarean section is described in a patient with von Hippel-Lindau disease. The reasons for the choice of epidural anaesthesia are explained and the anaesthetic significance of the disease is discussed.