[Compression stockings as prevention of hypotension in Cesarean section during spinal anesthesia]. / Kompressionsstrømper som profylakse mod hypotension ved sectio i spinalanaestesi.

Inflatable splints and wrapping of the legs have been shown to be effective against hypotension during spinal anaesthesia for Caesarean section. The aim of this study was to investigate if compression stockings could have a similar effect. Thirty healthy mothers scheduled for elective Caesarean section were randomised to have either compression stockings or no stockings on before spinal anaesthesia. The stockings had a pressure effect of 54 mmHg. The women were preloaded with 20 ml isotonic NaCl one hour preoperatively. Hypotension was defined as either a decrease in systolic blood pressure to 80% of preoperative values or systolic blood pressure under 100 mmHg. Blood pressure was measured every second minute, and ephedrine 5 mg was given in the presence of hypotension. Two patients were excluded in the control group. There were no differences in demographic data, extension of blockade, and spinal injection to delivery time. Nine patients in the group with stockings had either no fall in blood pressure or a fall in blood pressure corrected with only 5 mg ephedrine. In the control group the corresponding number was four patients (p < 0.12). Ephedrine dose between zero and 20 minutes and total ephedrine dose was significantly lower in the group with stockings than in the control group (p < 0.038). Five patients in the control group experienced nausea, no patients in the study group had nausea (p < 0.013). In conclusion, compression stockings stabilised the blood pressure during Caesarean section in spinal anaesthesia and led to a significant smaller need for ephedrine.

[Spinal analgesia for cesarean section]. / Spinal analgesi til sectio caesarea.

Over a twelve-month period, 47 of a total of 127 women had spinal anaesthesia (SA) for caesarean section (SC). Data from the anaesthesia and the postoperative period were collected and a questionnaire was sent to the mothers after discharge. The analgesia was sufficient in 45 patients. Two had general anaesthesia (GA). One further patient had GA because of overwhelming anxiety. Despite crystalloid preloading, 45% had a significant decrease in systolic blood pressure. Hypotensive cases were treated with a bolus of ephedrine i.v. Forty-one of the new-born babies scored Apgar 10/1 and all scored 10/5. No postdural puncture headaches were observed during the patients' stay in hospital. Forty women answered the questionnaire, and of these, 38 said they would prefer SA in the event of future SC. Six out of eight women who had previously had epidural analgesia preferred SA. We find that SA is a safe, easy, and reliable method for SC, although supplementary analgetic and antiemetic may be needed, but it is mandatory to maintain the systolic blood pressure (cardiac output) close to the preanalgetic values.

[Magnetic resonance imaging (MRI) in central pontine myelinolysis]. / Magnetisk resonans billeddannelse (MRI) ved central pontin myelinolyse.

Three cases of central pontine myelinolysis (CPM) including magnetic resonance (MRI), are presented and the literature describing the pathological physiological background for the appearance in MRI is reviewed. MRI is recommended as the method of choice in cases of suspected CPM.

[Cerebral symptoms in hyponatremia. Treatment and course]. / Cerebrale symptomer ved hyponatriaemi. Behandling og forløb.

Pronounced hyponatraemia results in serious neurological symptoms and the untreated condition is associated with a great mortality. An account is presented of nine hyponatraemic patients (plasma sodium 101-119 mmol/l) without cardiac, renal or hepatic disease who were admitted to a department for intensive care. In all of the patients, consciousness was compromised. Three patients had generalized convulsions and six patients had respiratory involvement which required respirator treatment in two patients. In one patient, the hyponatraemia had developed acutely. The remaining cases had developed chronically. One patient was confused for one month after admission and another patient developed classical central pontine myelinolysis after a latent period of seven days and which required admission for rehabilitation for several months. The remaining patients, including the acute patient, had recovered completely after a few days. The rate of correction for plasma sodium was calculated for the patients. Animal experimental and clinical accounts concerning the pathological physiology and treatment of hyponatraemia are reviewed. It is important to differentiate between acutely and chronically developed hyponatraemia as treatments differ considerably. Severe chronic hyponatraemia should be treated with a rate of correction of plasma sodium of 0.5 mmol/l/hour, and the normal range for plasma sodium should be aimed at after a couple of days. The risk involved in more rapid normalization is development of central pontine myelinolysis with severe neurological sequelae. Hypertonic sodium chloride must only be employed in cases of acutely developed hyponatraemia with convulsions. Acute hyponatraemia may otherwise be corrected with a rate of correction of plasma sodium of 1 mmol/l/hour or more.

[Disseminated intravascular coagulation and pneumococcal septicemia after splenectomy]. / Dissemineret intravaskulaer koagulation og pneumokokseptikaemi efter splenektomi.

Two cases of fulminant pneumococcal septicaemia are reported. These occurred 18 and 25 years after splenectomy. These patients had not received pneumococcal vaccination. Disseminated intravascular coagulation developed early and was of decisive significance for the course of the illness with lethal issue. The characteristic clinical picture in pneumococcal speticaemia in asplenic patients may be misinterpreted initially as influenza and meticulous observation is therefore necessary and antibiotic treatment according to current guidelines should be initiated as early possible in febrile episodes.