1/19. Combined spinal-epidural anesthesia for cesarean section in a patient with peripartum dilated cardiomyopathy.PURPOSE: To report a case of peripartum dilated cardiomyopathy associated with morbid obesity and possible difficult airway presenting for elective cesarean section, which was successfully managed with combined spinal-epidural anesthesia. CLINICAL FEATURES: A morbidly obese parturient with a potentially difficult airway, suffering from idiopathic peripartum cardiomyopathy (ejection fraction 20%), was scheduled for an elective cesarean section. A combined spinal epidural anesthesia was performed and 6 mg of bupivacaine were injected into the subarachnoid space. This was supplemented after 60 min with 25 mg of bupivacaine injected epidurally. The patient's hemodynamic status was monitored with direct intra-arterial blood pressure and central venous pressure measurements. The patient's perioperative course was uneventful. CONCLUSION: In patients suffering from peripartum cardiomyopathy, undergoing cesarean section, combined spinal-epidural anesthesia may be an acceptable anesthetic alternative.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/19. When to remove an epidural catheter in a parturient with disseminated intravascular coagulation.BACKGROUND AND OBJECTIVES. Pain from labor and delivery is often attenuated with epidural anesthesia. A complication of indwelling epidural catheters is intraspinal hematoma. The development of a bleeding diathesis can worsen complications markedly. CONCLUSIONS. Frequent assessment of neurologic status is important until the underlying cause of the coagulopathy can be treated and the bleeding resolves. If there is no indication of intraspinal bleeding, we recommend removing the catheter because of potential catheter migration. If bleeding is occurring around the catheter insertion site and possibly in the epidural or subarachnoid space, the catheter may be left in place to tamponade the insertion site. In cases of intraspinal hematoma, which can cause neurologic deficits, immediate decompression surgery is needed.- - - - - - - - - - ranking = 0.42857142857143keywords = spinal (Clic here for more details about this article) |
3/19. Severe maternal bradycardia and asystole after combined spinal-epidural labor analgesia in a morbidly obese parturient.Serious maternal bradycardia and asystole in laboring parturients after combined spinal-epidural labor analgesia are rare. We report such a case in a morbidly obese laboring parturient after receiving combined spinal-epidural labor analgesia. The differential diagnosis, risk factors, potential contributing factors, and the successful management of the complications with our positive patient outcome are discussed. Even with the low dose of neuraxial drugs commonly administered in combined spinal-epidural labor analgesia, this case underscores the importance of vigilance, frequent monitoring, proper positioning, and rapid resuscitation with escalating doses of ephedrine, atropine, and epinephrine, all of which are essential in the presence of bradycardia or asystole in these patients.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
4/19. Spontaneous acute thoracic epidural hematoma causing paraplegia in a patient with severe preeclampsia in early labor.This is a case of acute spontaneous thoracic epidural hematoma in a laboring patient at term who presented with severe preeclampsia and acute spinal cord compression, paraplegia, and sensory loss below T8. In early labor, at home, the patient experienced sudden lumbar back pain that progressed to mid-scapular pain leading to paraplegia and T8 sensory loss within one hour of onset of pain. Her symptoms were caused by a spontaneous thoracic epidural hematoma. Upon arrival at the first hospital, the correct presumptive diagnosis was made in the emergency room, magnesium sulfate was administered, and the patient was transferred to our medical center. Her hypertension was not treated despite severe preeclampsia in order to maintain spinal cord perfusion pressure. Following cesarean section under general anesthesia, thoracic laminectomy was performed and an epidural hematoma compressing the spinal cord to 2-3 mm was evacuated 13 h after the onset of symptoms. After approximately three months of paraplegia, five months with quad-walker and cane use, the patient can now walk with a cane or other minimal support but has remaining bowel and bladder problems. The conflicting anesthetic management objectives of severe preeclampsia and acute paraplegia secondary to spinal epidural hematoma required compromise in the management of her preeclampsia in order to preserve spinal cord perfusion.- - - - - - - - - - ranking = 0.71428571428571keywords = spinal (Clic here for more details about this article) |
5/19. Obstetrical anaesthesia and analgesia in chronic spinal cord-injured women.Improved acute and rehabilitative care and emphasis on integrating patients into society after spinal cord injury is likely to result in increasing numbers of cord-injured women presenting for obstetrical care. Anaesthetists providing care to these women should be familiar with the complications resulting from chronic cord injury and aware that many may be aggravated by the physiological changes of normal pregnancy. These complications include reduced respiratory volumes and reserve, decreased blood pressure and an increased incidence of thromboembolic phenomena, anaemia and recurrent urinary tract infections. patients with cord lesions above the T5 spinal level are at risk for the life-threatening complication of autonomic hyperreflexia (AH) which results from the loss of central regulation of the sympathetic nervous system below the level of the lesion. Sympathetic hyperactivity and hypertension result in response to noxious stimuli entering the cord below the level of the lesion. Labour appears to be a particularly noxious stimulus and patients with injuries above T5 are at risk for AH during labour even if they have not had previous AH episodes. morbidity is related to the degree of hypertension and intracranial haemorrhage has been reported during labour and attributed to AH. We report our experience in providing care to three parturients with spinal cord injuries. Two patients had high cervical lesions, one of whom experienced AH during labour and was treated with an epidural block. The second was at risk for AH having had episodes in the past and received an epidural block to provide prophylaxis for AH. In both cases epidural blockade provided effective treatment and prophylaxis for AH.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 11755.934390854keywords = autonomic hyperreflexia, hyperreflexia, spinal (Clic here for more details about this article) |
6/19. Epidural catheter-induced paresthesia accompanied by changes in skin color and temperature in an obstetric patient.Placement of epidural catheters for labor analgesia is a common procedure that has become more popular in recent years. However, this procedure can often cause paresthesia, which is typically characterized as a transient and intense burning pain radiating to the hip or leg. In this case report, we describe a patient who had persistent paresthesia in her right foot caused by an indwelling epidural catheter, which was successfully relieved following a partial withdrawal of the epidural catheter. More interestingly, we also observed dramatic changes in skin color and temperature (cold and pale) on her right foot that was well correlated both in time and location with the epidural-induced paresthesia. This cold and pale skin on the right foot represents a localized sympathetic discharge associated with the epidural-induced paresthesia, a phenomenon that has not previously been described. Based on the location of the paresthesia and the pathway of the sympathetic nerve fibers, it is unlikely that this localized sympathetic discharge was due to a direct irritation of the preganglionic sympathetic fibers in the spinal nerve roots by the epidural catheter and thus, a spinal reflex was probably involved. This phenomenon provided us with additional clinical evidence of nerve root irritation, which prompted us to act quickly, and resulted in a favorable outcome.- - - - - - - - - - ranking = 0.28571428571429keywords = spinal (Clic here for more details about this article) |
7/19. Angle closure glaucoma precipitated by labour.Acute angle closure glaucoma generally occurs in older hypermetropic individuals, precipitated by pupillary dilation. However it is often forgotten that it can occur in younger people and that it does not occur solely as a result of the use of mydriatics or normal pupillary dilation in response to darkness. It is recognised that it can occur during or shortly after a surgical procedure done under either spinal or general anaesthetic. We describe a case of acute angle closure occurring in a 37-year-old woman, precipitated by labour. To our knowledge no such case has been described in the literature.- - - - - - - - - - ranking = 0.14285714285714keywords = spinal (Clic here for more details about this article) |
8/19. Postpartum femoral neuropathy: relic of an earlier era?femoral neuropathy after childbirth is rarely encountered today, although around 1900 an incidence of up to 4.7% was found. A case of postpartum unilateral femoral neuropathy in a 29-year-old primigravida is described. The patient's labor was complicated by poor progression, a prolonged second stage (three hours), and midforceps delivery. The patient received both epidural anesthesia (requiring catheter manipulation) and spinal anesthesia. Total time in the dorsal lithotomy position was four hours; total duration of labor was 27 hours. After delivery, the patient experienced buckling at the right knee and numbness down the leg anteriorly. The electromyogram at one month was consistent with an acute femoral neuropathy. Information about other cases of postpartum lower extremity neuropathy was obtained by a retrospective review of all deliveries at a large maternity hospital between 1971 and 1987. Of 143,019 live births, there were three other cases of postpartum knee extensor weakness (2.8/100,000), five cases of postpartum footdrop (3.5/100,000), and two cases of meralgia paresthetica (1.4/100,000). Although the precise mechanism of injury remains unclear, the declining incidence of femoral neuropathy may reflect decreased duration of labor with modern obstetric practices, particularly more frequent Cesarean delivery.- - - - - - - - - - ranking = 0.14285714285714keywords = spinal (Clic here for more details about this article) |
9/19. Autonomic hyperreflexia, cesarean section and anesthesia. A case report.Autonomic hyperreflexia, a potentially life-threatening condition, can appear during labor, delivery or cesarean section in a woman with a spinal cord injury. A case of autonomic hyperreflexia in a parturient was managed with regional neural blockade.- - - - - - - - - - ranking = 21331.117505623keywords = autonomic hyperreflexia, hyperreflexia, spinal (Clic here for more details about this article) |
10/19. Autonomic hyperreflexia: a mortal danger for spinal cord-damaged women in labor.Reproductive care of women with spinal cord damage demands knowledge of such women's reproductive potential and the specific complications to which these women are prone during pregnancy and childbirth, especially autonomic hyperreflexia. fertility in cord-damaged women of reproductive age is generally undiminished as are libido, ability to have intercourse, and ability to bear children. Frequent complications of cord-damaged pregnant women include urinary tract infection, anemia, pressure sores, sepsis, unattended birth, and autonomic hyperreflexia. Autonomic hyperreflexia or autonomic dysreflexia occurs during labor in up to two thirds of women with cord lesions above T-6. Autonomic hyperreflexia results from noxious stimuli including distention of the bladder, cervix, or rectum, which evokes mass triggering of sympathetic and parasympathetic afferents that are uninhibited by supraspinal centers below the cord lesion. Autonomic hyperreflexia manifests itself with sudden onset of marked hypertension and headache during uterine contractions, as well as bradycardia or tachycardia, various cardiac dysrhythmias, and marked diaphoresis with piloerection and flushing above the level of the cord lesion. We describe the second reported occurrence of intraventricular hemorrhage due to autonomic hyperreflexia during labor and detail recommendations for anticipating and mitigating this potentially lethal complication of parturition in cord-damaged women. pregnancy and parturition are best carried out with informed cooperation of the patient and of obstetric, cord rehabilitation, anesthetic, and nursing personnel.- - - - - - - - - - ranking = 38832.390336767keywords = autonomic hyperreflexia, hyperreflexia, spinal (Clic here for more details about this article) |
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