ABSTRACT
Acute fatty liver of pregnancy (AFLP) is a rare, but serious life-threatening clinical entity, the etiology of which is unknown. The clinical presentation of this disease is varied and timely diagnosis often difficult. Since multiorgan involvement (and dysfunction) complicates diagnosis, no uniform peripartum obstetric and anesthetic recommendations can be made. Still, once the diagnosis of AFLP is established, prompt delivery is indicated. We herein present a case of acute fatty liver and hepatic failure that developed during the third trimester of pregnancy. Favorable maternal and fetal outcome was accomplished.
Subject(s)
Fatty Liver/therapy , Pregnancy Complications/therapy , Acute Disease , Adult , Diagnosis, Differential , Fatty Liver/diagnosis , Female , Humans , Postpartum Period , Pregnancy , Pregnancy Complications/diagnosisABSTRACT
BACKGROUND: The best combination of bolus size and lockout interval for patient-controlled epidural analgesia (PCEA) is not known. This study compared a 5-min with a 15-min lockout interval. METHODS: Parturients were randomly assigned to receive PCEA with either a 5-min or a 15-min interval. All had a 15-mL loading dose, continuous background infusion 6 mL/h of 0.125% bupivacaine plus fentanyl 2 mug/mL, PCEA bolus volume 5 mL, maximum hourly dose 26 mL. Visual analogue scores for pain, nausea and pruritus, sensory levels to ice, sacral analgesia, motor power, blood pressure and fetal heart rate were assessed pre-epidural and regularly thereafter until delivery. The numbers of boluses and attempts and patient satisfaction were recorded. RESULTS: 29 patients were assigned to the 5-min group and 31 to the 15-min group, but the 15-min group contained twice as many nulliparous women. Side-effect and complication rates did not differ between groups. VAS pain scores were reduced from a median of 79 in the 15-min group and 82 in the 5-min group to a median of zero 30 min after epidural insertion. Bolus/attempt ratio was 0.88 in the 5-min vs. 0.70 in the 15-min group. The numbers of requests for physician intervention were similar. No differences in pain scores, side-effects, drug use or patient satisfaction were demonstrated. CONCLUSION: The 5-min lockout interval appears the more efficient and has been used safely in our practice for 15,000 parturients, although a larger study is required to confirm the relative efficacy, efficiency and safety of this regimen.
