RESUMO
BACKGROUND: The number of women receiving neuraxial anaesthesia for labour and delivery is increasing. Women are also being discharged into the community sooner after delivery. Thus, complications arising from neuraxial anaesthesia may present to general practitioners, so it is of vital importance that they are familiar with and can manage potential problems associated with these anaesthetic techniques. METHODS: A questionnaire was sent to 126 local general practitioners to discover their knowledge of the symptoms, diagnosis and treatment of post dural puncture headache in the parturient. An information leaflet was then circulated to all general practitioners in the region, detailing headaches and other potential problems following epidural analgesia for childbirth, and the questionnaire was reissued. RESULTS: The first questionnaire demonstrated that they had poor knowledge of the symptoms, diagnosis and treatment of post dural puncture headache in the parturient. Following the dissemination of the information leaflet, responses to the second questionnaire showed a significant improvement. CONCLUSION: By comparing the two sets of answers, we demonstrated that the leaflet has successfully improved knowledge of post dural puncture headache and other potential sequelae of obstetric epidural analgesia among general practitioners.
Assuntos
Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Educação Continuada , Medicina de Família e Comunidade/educação , Folhetos , Cefaleia Pós-Punção Dural , Escolaridade , Feminino , Humanos , Cefaleia Pós-Punção Dural/complicações , Cefaleia Pós-Punção Dural/diagnóstico , Cefaleia Pós-Punção Dural/terapia , GravidezRESUMO
PURPOSE: To present an unusual case of inappropriate antidiuretic hormone secretion syndrome after a minor surgical procedure in a healthy patient. CLINICAL FEATURES: A 71-yr-old woman underwent uneventful laparoscopic cholecystectomy for gallstones under general anaesthesia. Fifty-two hours post operatively she began convulsing and was found to have a serum sodium concentration as low as 112 mmol.L-1. Serum osmolality, urinary sodium concentration and urine osmolality suggested a diagnosis of inappropriate antidiuretic hormone secretion. Subsequent treatment with anticonvulsants followed by strict fluid restriction which increased serum sodium concentrations led to rapid recovery. CONCLUSION: The syndrome of inappropriate ADH secretion has several well documented causes including major surgery. Few episodes have been described following minor surgery in healthy patients and the only possible risk factor evident in this patient could be her advancing years.
