Combined General and Epidural Anesthesia for Emergency Cesarean Delivery of Twins in a Parturient With Coarctation of Aorta.

Pregnancy is associated with increased coarctation-associated complications. We report the successful management of emergency lower-segment cesarean delivery in a patient with coarctation of aorta. A parturient at 34 weeks of gestation of a twin pregnancy with uncorrected coarctation of aorta was taken for emergency lower-segment cesarean delivery to be performed using epidural anesthesia. A mixture of lignocaine (lidocaine), bupivacaine, and fentanyl was administered epidurally. In view of unsatisfactory motor action, general anesthesia had to be administered. However, because of sufficient analgesia due to the epidural drugs, optimal hemodynamic control was achieved. A combination of general and epidural anesthesia minimizes adverse effects of coarctation of aorta, with improved maternal and fetal outcomes.

Conscious sedation for balloon mitral valvotomy: A comparison of fentanyl versus sufentanil.

CONTEXT: Analgesia and sedation are required for the comfort of patient and the cardiologist during balloon mitral valvotomy. AIMS: In this study, efficacy of analgesia, sedation, and patient satisfaction with sufentanil was compared with fentanyl. SETTINGS AND DESIGN: Single-centered, prospective single-blind study of sixty patients. MATERIALS AND METHODS: Patients between 15 and 45 years of rheumatic mitral stenosis with valve area of 0.8-1 cm2 undergoing elective balloon mitral valvotomy, randomly divided to receive bolus injection fentanyl 1 mcg/kg (Group 1, n = 30) followed by infusion at 1 mcg/kg/h or bolus of injection sufentanil 0.1 mcg/kg (Group 2, n = 30) followed by continuous infusion at 0.1 mcg/h. Both the groups received injection midazolam bolus 0.02 mg/kg followed by infusion at 15 mcg/kg/h. Pain intensity (by visual analog score [VAS]), level of sedation (by Ramsay sedation scale), overall patient and operator's satisfaction, effect on cardiorespiratory parameters, and discharge score (by modified Aldrete score) were assessed. STATISTICAL ANALYSIS USED: Statistical analysis used Student's unpaired t-test and Chi-square test. P < 0.05 was considered statistically significant. RESULTS: Mean number of bolus doses in fentanyl group was 0.9 versus 0.13 in sufentanil group (P < 0.01). The mean value of mean blood pressure in fentanyl group was 83.52 mmHg versus 88 mmHg in sufentanil group (P < 0.05), but the value was within normal range in both the groups. The mean VAS - patient's opinion in fentanyl group was 8.97 versus 9.53 in sufentanil group (P < 0.05). Mean discharge score in fentanyl group was 17.87 versus 18.23 in sufentanil group (P < 0.05). No statistically significant difference was found with respect to heart rate, respiratory rate, oxygen saturation, PaCO2values, and anxiety scores. CONCLUSION: Sufentanil was found to be better with respect to analgesia, patient satisfaction, and recovery however not cost-effective for continuous infusion technique.

Successful management of a broken epidural catheter!!!

Breakage of epidural catheter though rare is a well-known but worrisome complication. Visualization of retained catheter is difficult even with modern radiological imaging techniques, and active surgical intervention might be necessary for removal of catheter fragment. We report such a case of breakage of an epidural catheter during its removal which led to surgical intervention.