[Anesthetic management of a cervicoisthmic pregnancy patient undergoing cesarean section].

Cervicoisthmic pregnancy is a rare obstetric condition that is potentially dangerous for the pregnant woman due to a high risk of abortion or preterm delivery. We here present a 29-year-old woman with cervicoisthmic pregnancy undergoing cesarean section at full-term. Under combined epidural and spinal anesthesia, an infant was delivered alive, and the placenta was preserved without any forces to detach from the uterus. The surgery was completed without massive bleeding. The retained placenta was treated with methotrexate infusion into the uterus from the 6th day as well as uterine artery embolization at the 51th day postpartum. She subsequently required manual removal of the retained placenta under combined epidural and spinal anesthesia with only small bleeding. She was discharged from our hospital uneventfully. Meticulous preparation for massive bleeding and long-term treatment of the retained placenta are important in the perioperative management for cesarean section of a full-term patient with cervicoisthmic pregnancy.

[A case of femoral neuropathy after radical ovariectomy].

We experienced a 55-year-old female patient who was diagnosed as femoral neuropathy after radical ovariectomy. An epidural catheter was introduced at T11-12 interspace without any problems and general anesthesia was induced and maintained. The operation ended uneventfully. On the first postoperative day, she noticed hypesthesia of the inner surface of her left thigh and could not raise the left leg. The symptom remained after the removal of epidural catheter on the second postoperative day, and the influence of insertion of the epidural catheter on the symptom was suspected. We performed neurological examinations and found weakness of the left quadriceps femoris muscle, weakness of the left patellar reflex, and weakness of touch sensation and cold sensation and hypalgesia on the anterior surface of the left thigh and the inner surface of the left lower leg. Those findings led us to diagnose with femoral neuropathy probably due to abdominal retractors or the operation itself, and insertion of epidural anesthesia could not be the cause of neuropathy. Her symptom was ameliorated with a conservative therapy after four months. We should perform fine neurological examinations when neurological complications occur, especially when we use epidural catheters, and also should have the knowledge about those complications.

[Anesthetic management of a parturient with congenital afibrinogenemia undergoing cesarean section].

A 29-year-old parturient with congenital afibrinogenemia was scheduled to receive cesarean section 38 weeks 2 days of gestation. Due to the bleeding ter dency by her abnormality of fibrinogen and afibrinogenemia, general anesthesia was chosen. In addition to routine administration of fibrinogen, perioperative supplementation of fibrinogen with the meticulous evaluation of the coagulation and fibrinolysis status using rotation thromboelastometry (ROTEM) enabled the patient to deliver a healthy baby without any hematological complications. The ROTEM was a useful device to check coagulopathy and fibrinolysis in this patient.