[Apnea after general anesthesia for revision of uterus in parturient with K-variant of the butyrylcholinesterase enzyme (BChE)].

A 30 years old parturient was admitted to the operating theatre for revision of uterus after spontaneous labor because of hemorrhage. She underwent general anesthesia induced by rapid sequence induction (RSI) technique. Apnea for 45 minutes was observed after succinylcholine administration. Biochemistry laboratory tests from the operation day showed very low butyrylcholinesterase activity, and a repeated test after one month showed normal enzyme activity and inhibitors within the normal range. Genetic tests revealed heterozygosity for the K variant of BChE. This may explain the increased sensitivity to succinylcholine during pregnancy.

Accidental venous and dural puncture during epidural analgesia in obese parturients (BMI > 40 kg/m2): three different body positions during insertion.

STUDY OBJECTIVE: To assess the frequency of blood vessel punctures in morbidly obese parturients [body mass index (BMI) > 40 kg/m(2)] during epidural catheterization, in three different body positions. DESIGN: Prospective, randomized study. SETTING: Delivery room of a university-affiliated hospital. PATIENTS: 347 obese parturients (BMI > 40 kg/m(2)) undergoing continuous epidural analgesia during labor. INTERVENTIONS: Patients were randomized to undergo epidural catheterization in the sitting, lateral recumbent horizontal, or lateral recumbent head-down positions. MEASUREMENTS AND MAIN RESULTS: A lower frequency of epidural venous cannulation was noted when this procedure was performed in the lateral recumbent head-down position (4.8%) than in the lateral recumbent horizontal (11.6%) or sitting position (18.3%) (P = 0.001). Frequency of accidental subarachnoid puncture did not differ significantly (2.5%, 2.6%, and 3.7%), respectively. CONCLUSION: Adoption of the lateral recumbent head-down position for the performance of lumbar epidural blockade in labor at term reduces the frequency of lumbar epidural venous puncture in obese parturients (BMI > 40 kg/m(2)).

Intracavernosal saline infusion decreases intraoperative blood loss during radical retropubic prostatectomy.

OBJECTIVE: Radical retropubic prostatectomy (RRP) is associated with intraoperative blood loss. We studied whether regional hemodilution using intracavernosal saline infusion has an impact on blood loss during RRP. METHODS: This is a prospective, randomized controlled study. There were 16 patients treated with intracavernosal saline infusion, and 17 did not receive infusion and served as the control group. Patients who received neoadjuvant therapy and those who underwent pelvic lymph node dissection or salvage RRP were excluded. Both corpora were infused in a pressure of 80-cm water. Clinical, pathologic, and laboratory parameters were evaluated and compared. Intraoperative actual blood loss was calculated. RESULTS: Blood loss was significantly higher in the control group (1,036 +/- 176 vs. 482 +/- 184 ml; P < 0.001). Postoperatively, 3 control patients received 2 packed-cell units each. There were no differences between the 2 groups in regard to patient's age, comorbidities, body mass index, American Society of Anesthesiologists score, prostate-specific antigen level, clinical or pathologic stage, Gleason score, prostate specimen weight, and operating time. Localized penile edema developed in 6 patients (37.5%) that resolved spontaneously 48 hours postoperatively. None of the patients had symptoms or signs of systemic fluid overload. CONCLUSION: Our result indicates that localized hemodilution using intracavernosal saline infusion is feasible, safe, and significantly decreases blood loss during RRP.

Total cell associated electrolyte homeostasis in rat spinal cord cells following apparently irreversible injury.

BACKGROUND: We investigated total electrolyte homeostasis in spinal cord cells of rats subjected to irreversible spinal cord trauma. MATERIAL/METHODS: Forty-two rats underwent total transection of spinal cord (Group 1); chemical neurolysis by 10% lidocaine overdose (Group 2); sham "injury" (Group 3). Spinal cords were isolated 24 h, 72 h or 7 days following injury. Total cellular Ca, Mg, Na and K were measured in the spinal cord thoracic or lumbar parts using an atomic absorption spectrometer. RESULTS: Group 1: A significant Ca, Mg, Na, and K efflux was observed in thoracic and lumbar parts 24 h following transection. By 72 h, a significant re-entrance of Ca was evident. By 168 h, an influx of all electrolytes was demonstrable, sometimes reaching concentrations above the pre-trauma levels. Group 2: Following 24 h, Na, K, Ca, and Mg concentrations dropped significantly both in thoracic and lumbar parts. By 72 h, the electrolyte re-entrance was evident in the thoracic, but not the lumbar part. By 168 h, Na, K, Ca, and Mg influx was observed both in thoracic and lumbar parts, the concentration approaching pre-trauma levels. Group 3: No changes in electrolyte content were observed in spinal cords of sham-operated animals. CONCLUSIONS: Following massive, apparently irreversible injury of the spinal cord, some restorative processes do take place at the cellular level. Subsequent supernormal accumulation of intracellular electrolytes, especially Ca, might eventually contribute to a secondary injury. Should this be the case, pharmacotherapeutic intervention might prove beneficial.

The lateral recumbent head-down position decreases the incidence of epidural venous puncture during catheter insertion in obese parturients.

PURPOSE: The unintentional and unrecognized cannulation of an extradural vein is a potentially serious complication of an epidural anesthetic. The present study was undertaken to assess the incidence of blood vessel puncture related to epidural catheterization in three different body positions, in a cohort of morbidly obese parturients, following the completion of a similar study published in 2001 from which such parturients were excluded. METHODS: The study was conducted in 450 (three groups of 150) morbidly obese, obstetric patients undergoing continuous epidural analgesia during labour. Epidural catheterization was performed on patients randomized to the sitting, lateral recumbent horizontal, or lateral recumbent head-down position. RESULTS: There was a lower incidence of vessel cannulation when this procedure was performed in the lateral recumbent head-down position [1.3%; body mass index (BMI): 37.0] than in the lateral recumbent horizontal [12.9%; BMI: 38.0] and in the sitting position [12.0%; BMI: 38.0]. The incidence of accidental subarachnoid puncture was 2%, 1.3% and 2% respectively, in these same positions. CONCLUSION: Adoption of the lateral recumbent head-down position for the performance of lumbar epidural blockade, in labour at term, reduces the incidence of lumbar epidural venous puncture in these obese parturients.

Characteristics of maternal heart rate patterns during labor and delivery.

OBJECTIVE: To find patterns characteristic of maternal heart rates recorded by an electronic fetal monitor and compare them with concomitant fetal heart rate (FHR) patterns. METHODS: Maternal heart rates and FHRs during active labor and delivery were simultaneously recorded in 26 parturients with singleton pregnancies in vertex presentation. The FHRs were obtained by an external ultrasound transducer or via a spiral scalp electrode and maternal heart rates by a triple-wire cable with electrocardiographic electrodes attached to the chest. Representative tracings of 30-60 minutes duration were selected from all stages of labor and after delivery of the placenta. Quantitative assessments were carried out under guidelines from the National Institute of Child Health and Human Development after blinding the source of these tracings. Patterns were compared by appropriate statistical analyses. RESULTS: Baseline maternal heart rates were significantly lower and their variability significantly higher than FHRs during all stages of labor. Maternal heart rates showed no decelerations; the proportion of tracings with accelerations increased as labor advanced, most of them coinciding with uterine contractions or bearing down efforts. The FHRs had both decelerations and accelerations. However, tracings with only accelerations (and no decelerations) were observed in decreasing frequency as labor advanced. Maternal accelerations had higher amplitudes and longer durations than fetal accelerations, especially in the second stage of labor. CONCLUSION: Maternal heart rate patterns recorded by electronic fetal monitors closely resemble fetal patterns. Baseline "fetal bradycardia," the absence of decelerations in the second stage of labor, and marked accelerations coinciding with uterine contractions may suggest a maternal heart rate rather than an FHR recording.