ABSTRACT
During a transforaminal lumbar interbody fusion a patient experienced acute intermittent bradycardia with manipulation of the intervertebral body space, followed by loss of somatosensory evoked potentials that did not recover. Postoperative evaluation revealed new bilateral lower extremity sensory and motor deficits. We postulate an afferent reflex arc to explain this and other reported instances of bradycardia and asystole during transforaminal lumbar interbody fusion surgery. Awareness of the association between bradycardia during lumbar spine surgery may alert anaesthetists, surgeons and neuromonitoring teams to impending neurological harm.
ABSTRACT
The vast majority of females affected by hemochromatosis are asymptomatic during childbearing years. We were able to provide effective obstetric anesthesia care to a 35-year-old woman with severe hemochromatosis. She had systolic heart failure with a left ventricular ejection fraction of 15%, severe pulmonary hypertension, mitral insufficiency, a history of ventricular tachycardia, cirrhosis, obstructive sleep apnea, gestational diabetes, and severe scoliosis. A multidisciplinary approach was used to stabilize her heart failure and prepare her for childbirth. An arterial line and epidural analgesic were placed before induction of labor. Vaginal delivery was accomplished with passive decent of the fetus and forceps assistance. We discuss hemochromatosis and its implications for the parturient.
