ABSTRACT
A primiparous, full-term, 28-year-old woman underwent an emergency lower segment Caesarean section under epidural anaesthesia for failure to progress in the first stage. Despite an uneventful pregnancy and delivery, she developed a hypertensive crisis in the postoperative period complicated by acute pulmonary oedema requiring ventilation for 48 h in the intensive care unit. Intravenous magnesium sulphate infusions and hydralazine boluses were used to control the blood pressure, which was associated with clonus, hyperreflexia, tachycardia and profuse sweating. The patient made a good recovery. Later measurement of urinary catecholamines in the recovery phase showed greatly elevated levels of norepinephrine, dopamine and vanillyl mandelic acid. Further investigations included a normal abdominal computed tomography scan and a I-123 meta-iodo-benzyl-guanidine scintigraphy scan which revealed a 3- to 4-cm irregular tumour located at the level of the lower pole of the right kidney and further liver hot spots. Intravenous magnesium sulphate infusion proved successful in controlling hypertension caused by a phaeochromocytoma in the postpartum period.
Subject(s)
Adrenal Gland Neoplasms/complications , Hypertension/etiology , Pheochromocytoma/complications , Pregnancy Complications, Cardiovascular/etiology , Pregnancy Complications, Neoplastic , Adrenal Gland Neoplasms/diagnosis , Adrenal Gland Neoplasms/therapy , Adult , Anesthesia, Epidural , Anesthesia, Obstetrical/methods , Cesarean Section/methods , Diagnosis, Differential , Female , Humans , Hypertension/diagnosis , Hypertension/therapy , Magnesium Sulfate/therapeutic use , Pheochromocytoma/diagnosis , Pheochromocytoma/therapy , Pregnancy , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/therapy , Pregnancy Complications, Neoplastic/diagnosis , Pregnancy Complications, Neoplastic/therapy , Treatment OutcomeABSTRACT
BACKGROUND: We hypothesised that any peripheral action of morphine may contribute to improved postoperative analgesia. The aim of this study was to evaluate the analgesic efficacy of morphine administered preoperatively into an exsanguinated limb prior to total knee arthroplasty. METHODS: A randomised, double-blind, controlled study was performed in 50 patients having total knee arthroplasty surgery. Patients were divided into two groups. In the study group, 0.125 mg/kg morphine in 60 ml of saline was administered intravenously (iv) into the exsanguinated operative limb via a cannula in the foot. A saline intramuscular (im) injection was administered into the opposite leg. The control group received 60 ml saline iv into the operative leg and 0.125 mg/kg morphine im into the opposite leg. Pain was assessed postoperatively using a 10-point visual analogue scale and by comparing morphine requirements and demand:delivery ratios from a patient-controlled analgesic pump. RESULTS: We found no statistically significant difference between the groups in relation to any of the analgesic measures employed. CONCLUSIONS: Intravenous regional analgesia using morphine provides no analgesic advantage over the intramuscular route from 6-24 h postoperatively.
Subject(s)
Analgesics, Opioid/administration & dosage , Knee Prosthesis , Morphine/administration & dosage , Pain, Postoperative/therapy , Analgesia, Patient-Controlled , Anesthesia, Spinal , Double-Blind Method , Humans , Injections, Intramuscular , Injections, Intravenous , Knee Joint/surgery , Pain MeasurementABSTRACT
We describe hepatic rupture in a 37-yr-old woman admitted to the intensive care unit after an eclamptic convulsion. The intensive care and surgical management are discussed.
