Cardiac arrest in an obstetric patient using remifentanil patient-controlled analgesia.

This case report describes the management of a patient, diagnosed with an intrauterine death at 31 weeks' gestation, who suffered a cardiorespiratory arrest during her induced labour while using a remifentanil PCA. She made a full recovery from resuscitation which included a peri-mortem caesarean section.

Checking anaesthetic equipment 2012: association of anaesthetists of Great Britain and Ireland.

A pre-use check to ensure the correct functioning of anaesthetic equipment is essential to patient safety. The anaesthetist has a primary responsibility to understand the function of the anaesthetic equipment and to check it before use. Anaesthetists must not use equipment unless they have been trained to use it and are competent to do so. A self-inflating bag must be immediately available in any location where anaesthesia may be given. A two-bag test should be performed after the breathing system, vaporisers and ventilator have been checked individually. A record should be kept with the anaesthetic machine that these checks have been done. The 'first user' check after servicing is especially important and must be recorded.

Caesarean section in patients with heart-lung transplants: a report of three cases and review.

There are increasing numbers of combined heart-lung transplants being carried out in young people for end-stage pulmonary disease. There have-to-date been few reports of pregnancy in heart-lung transplant recipients. We report on the successful outcome of three pregnancies involving two patients following heart-lung transplantation. The importance of an interdisciplinary approach to the care of such patients throughout pregnancy is clear. The deliveries were carried out by caesarean section under regional anaesthesia and the discussion focuses on the choice of anaesthesia along with the problems these patients present to the anaesthetist. Regional anaesthesia appears to be a safe technique in these patients. However, it is important to appreciate that the response to vasoactive drugs may be unpredictable and that intravenous fluid should be administered carefully as they are at risk of fluid overload and pulmonary oedema.

Anaesthetic management of Caesarean section in an elderly parturient with pre-eclampsia.

The number of women over 40 years of age becoming pregnant has increased over recent years. They suffer a high incidence of hypertensive complications, and require more frequent operative interventions. We present a case report of a 51-year-old woman having a Caesarean section for a twin pregnancy complicated by pre-eclampsia. We discuss the effects of age on pregnancy and the implications for anaesthetic management.

Effects of epidural analgesia on plasma calcitonin gene-related peptide.

The effects of epidural analgesia on plasma calcitonin gene-related peptide (CGRP) values during and after hysterectomy were investigated in 14 healthy patients. In seven patients who received general anaesthesia alone for pelvic surgery, there were no significant changes in plasma CGRP concentrations. In the remaining patients, who received extensive epidural blockade in addition to general anaesthesia, there were again no significant changes in plasma CGRP values. This was in spite of profound sympathetic blockade, as shown by marked hypotension and a significant decline in plasma catecholamines. The epidural group of patients showed the expected attenuation of the glucose, cortisol and growth hormone responses to surgery. The results show that circulating CGRP is unlikely to be involved in the modulation of peripheral vascular tone during pelvic surgery under either general or epidural anaesthesia.