Sequential compression device with thigh-high sleeves supports mean arterial pressure during Caesarean section under spinal anaesthesia.

BACKGROUND: This study investigated the use of a Sequential Compression Device (SCD) with thigh-high sleeves and a preset pressure of 50 mm Hg that recruits blood from the lower limbs intermittently, as a method to prevent spinal hypotension during elective Caesarean section. Possible association of arterial pressure changes with maternal, fetal, haemodynamic, and anaesthetic factors were studied. METHODS: Fifty healthy parturients undergoing elective Caesarean section under spinal anaesthesia were randomly assigned to either SCD (n=25) or control (n=25) groups. A standardized protocol for pre-hydration and anaesthetic technique was followed. Hypotension was defined as a decrease in any mean arterial pressure (MAP) measurement by more than 20% of the baseline MAP. Systolic (SAP), MAP and diastolic (DAP) arterial pressure, pulse pressure (PP), and heart rate (HR) were noted at baseline and every minute after the spinal block until delivery. RESULTS: A greater than 20% decrease in MAP occurred in 52% of patients in the SCD group vs 92% in the control group (P=0.004, odds ratio 0.094, 95% CI 0.018-0.488). There were no significant differences in SAP, DAP, HR, and PP between the groups. CONCLUSION: SCD use in conjunction with vasopressor significantly reduced the incidence of a 20% reduction of MAP.

Anesthetic management of a pregnant patient with congenitally corrected transposition of the great arteries for labor and vaginal delivery.

A patient with congenitally corrected transposition of the great arteries (CCTGA), which is a rare form of congenital heart disease that is characterized by discordant atrioventricular and ventriculoarterial connections, was admitted for induction of labor at 40 weeks' gestation. This patient was first diagnosed with CCTGA at 20 weeks' gestation and had experienced recurrent supraventricular tachycardia (SVT) during her pregnancy. An early epidural infusion of local anesthetic and opioid was administered to decrease maternal catecholamine release and prevent tachycardia associated with labor pain. Noninvasive blood pressure, continuous lectrocardiography, and pulse oximetry were monitored, and supplemental oxygen was provided. Various cardiac medications were made immediately available to promptly treat a SVT if necessary. The patient remained hemodynamically stable throughout labor and vaginal delivery. The anatomical defects of CCTGA, associated conditions, physiologic concerns, and treatment options are reviewed.

Subarachnoid block for a patient with progressive chronic inflammatory demyelinating polyneuropathy.

IMPLICATIONS: We report a case of successful administration of a spinal anesthetic to a patient with progressive chronic inflammatory demyelinating polyneuropathy (CIDP). There have been no reports of regional anesthetic management of patients with CIDP.

Arm pain as an unusual presentation of postdural puncture intracranial hypotension.

IMPLICATIONS: We report a case of a patient experiencing severe arm pain after dural puncture. This complication has not been reported previously. The patient was successfully treated with an epidural patch.

Lumbar epidural analgesia for labor and vaginal delivery.

Lumbar epidural analgesia has become the preferred method of pain relief for labor and delivery. Proper administration of epidural analgesia offers many advantages for both mother and fetus. With the availability of various local anesthetics, opioids, and infusion techniques, the analgesia can be tailored to the specific needs of the mother, fetus, and labor. Its effect on the progress of labor remains a controversial topic subject to ongoing investigation.