Assuntos
Anestesiologia , Trabalho de Parto , Cuidado Pré-Natal/métodos , Anestesia Obstétrica , Feminino , Humanos , Gravidez , Reino UnidoRESUMO
We report the anaesthetic management of vaginal delivery in a woman with Friedreich's ataxia, who had hypertrophic cardiomyopathy and had previously undergone thoracic spinal fusion with Harrington rod fixation. Combined spinal-epidural analgesia was used. Options for the anaesthetic management of labour and delivery are discussed.
RESUMO
The combined spinal-epidural technique is widely used in obstetric anaesthetic practice. Epidural catheter migration through a dural hole is a theoretical but rarely described complication. We report a case of acute and life-threatening respiratory depression following administration of diamorphine through an epidural catheter after a single space combined spinal-epidural technique for caesarean section. We believe this complication occurred as a result of catheter migration through a dural hole into the subdural space and rupture of the thin arachnoid layer causing massive subarachnoid blockade.
RESUMO
We have compared 2% lignocaine 3.5 ml with 0.5% hyperbaric bupivacaine 3 ml in a randomized, double-blind study in 30 patients undergoing subarachnoid anaesthesia for transurethral surgery. A sensory level of T10 was produced more quickly (P = 0.0001) and maximum height reached sooner (P = 0.0002) with lignocaine, although there was a greater reduction in systolic arterial pressure (P = 0.03) and a trend towards slower heart rates (P = 0.056). Return of full sensory and motor function occurred earlier with lignocaine (P = 0.00005 and P = 0.02).
Assuntos
Raquianestesia/métodos , Anestésicos Locais , Bupivacaína , Lidocaína , Prostatectomia , Bexiga Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/efeitos dos fármacos , Método Duplo-Cego , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
We report the development of unconsciousness caused by hyperventilation in an otherwise healthy woman in labour. Extradural analgesia resulted in restoration of full consciousness and normal respiratory state. The pathophysiology of hyperventilation and aspects of respiratory physiology in pregnancy are discussed.
Assuntos
Analgesia Epidural , Hipoventilação/complicações , Complicações do Trabalho de Parto/etiologia , Inconsciência/etiologia , Adulto , Analgesia Obstétrica , Feminino , Humanos , Hipoventilação/terapia , Complicações do Trabalho de Parto/terapia , Gravidez , Inconsciência/terapiaRESUMO
We report the successful use of combined spinal and extradural anaesthesia for elective Caesarean section in a primigravid patient with Ehlers-Danlos type IV (EDS IV). EDS IV is a rare disorder with a high pregnancy-related mortality. Previous reports have not addressed the question of anaesthesia for delivery. It is not possible to be didactic about anaesthetic technique for such patients. The relative risks of general and regional anaesthesia must be discussed fully, and the risks weighed against the wishes of the woman and her partner.
Assuntos
Anestesia Epidural/métodos , Anestesia Obstétrica/métodos , Raquianestesia/métodos , Cesárea , Síndrome de Ehlers-Danlos , Complicações na Gravidez , Adulto , Feminino , Humanos , GravidezRESUMO
The causes, diagnostic features, and therapy of chronic spinal arachnoiditis are reviewed. Two unexpected results from attempted epidural injections (one of lignocaine and clonidine, and one of lignocaine, clonidine, and morphine) in patients with this condition are described. The anatomical abnormalities of the epidural and subarachnoid spaces in such patients and the consequent unpredictable and potentially dangerous results that may follow drug injection into these spaces are discussed.
