Pub Date : 2022-01-01DOI: 10.4103/joacc.joacc_97_21
Erhan Ozyurt
Background: Hypotension induced by spinal anaesthesia during caesarean section can have devastating effects on the parturient and foetus. This study investigated the ability to predict spinal anaesthesia-induced hypotension via the perfusion index and pleth variability index in the sitting position caesarean section. Materials and Methods: We enrolled 46 patients undergoing elective caesarean section in this study and used standard anaesthetic management in all patients. The haemodynamic parameters, perfusion index and pleth variability index of the patients were recorded at specific time points. Results: Hypotension occurred in 61.4% of the patients. There was a difference in the pleth variability index values between patients with and without hypotension at baseline as well as in the sitting position and after spinal anaesthesia (P = 0.023, 0.001, and 0.040, respectively). According to the receiver operating characteristic curve analysis, the pleth variability index value of the patients in the sitting position was a predictor of spinal anaesthesia-induced hypotension (area under the curve = 0.780, 95% confidence interval [CI]: 0.633–0.927, P = 0.001). The cut-off value of the pleth variability index (in the sitting position) for predicting hypotension was 20.5% (sensitivity: 76.5%, specificity: 70.4%). Multivariate logistic regression analysis revealed that an increased pleth variability index in the sitting position before spinal anaesthesia was an independent risk factor of spinal anaesthesia-induced hypotension (odds ratio: 0.78, 95% CI: 0.62–0.98, P = 0.034). Conclusion: The pleth variability index in the sitting position before spinal anaesthesia is a useful tool for predicting spinal anaesthesia-induced hypotension during caesarean section.
{"title":"Pleth variability index measured in the sitting position before anesthesia can predict spinal anesthesia-induced hypotension in cesarean section: An observational study","authors":"Erhan Ozyurt","doi":"10.4103/joacc.joacc_97_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_97_21","url":null,"abstract":"Background: Hypotension induced by spinal anaesthesia during caesarean section can have devastating effects on the parturient and foetus. This study investigated the ability to predict spinal anaesthesia-induced hypotension via the perfusion index and pleth variability index in the sitting position caesarean section. Materials and Methods: We enrolled 46 patients undergoing elective caesarean section in this study and used standard anaesthetic management in all patients. The haemodynamic parameters, perfusion index and pleth variability index of the patients were recorded at specific time points. Results: Hypotension occurred in 61.4% of the patients. There was a difference in the pleth variability index values between patients with and without hypotension at baseline as well as in the sitting position and after spinal anaesthesia (P = 0.023, 0.001, and 0.040, respectively). According to the receiver operating characteristic curve analysis, the pleth variability index value of the patients in the sitting position was a predictor of spinal anaesthesia-induced hypotension (area under the curve = 0.780, 95% confidence interval [CI]: 0.633–0.927, P = 0.001). The cut-off value of the pleth variability index (in the sitting position) for predicting hypotension was 20.5% (sensitivity: 76.5%, specificity: 70.4%). Multivariate logistic regression analysis revealed that an increased pleth variability index in the sitting position before spinal anaesthesia was an independent risk factor of spinal anaesthesia-induced hypotension (odds ratio: 0.78, 95% CI: 0.62–0.98, P = 0.034). Conclusion: The pleth variability index in the sitting position before spinal anaesthesia is a useful tool for predicting spinal anaesthesia-induced hypotension during caesarean section.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42550458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/joacc.joacc_85_21
K. Gupta, A. Ajith Kumar, Modhulika Bhattacharya, P. Murthy, K. Sarath
Introduction: To report a rare case of foetal gas gangrene following premature rupture of membranes in the second trimester diagnosed with the aid of computed tomography. Case Report: A 33-year-old lady, with G4A2L1, booked and vaccinated, developed premature rupture of membranes at 25 weeks of gestation. She developed severe abdominal pain with high-grade fever on the fourth night after expectant management with intravenous antibiotics and close monitoring. As there was a new-onset shock, she was referred to the higher centre from the obstetric care unit. The ultrasound of the abdomen and pelvis in the emergency room ruled out other causes of shock but confirmed intrauterine death. After planning for vaginal delivery, she had further deterioration requiring intubation and vasopressors. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis was performed which showed foetal gas gangrene and bilateral acute cortical necrosis. Emergency hysterotomy, performed under high-risk consent delivered macerated foetus. She had atonic uterus and required obstetric hysterectomy under general anaesthesia (GA). Her post-partum course was complicated by disseminated intravascular coagulopathy (DIC), acute respiratory distress syndrome (ARDS) and multiorgan dysfunction syndrome requiring multiple transfusions, prone ventilation and multiorgan support. However, she could not be salvaged and died on the 2nd day of surgery. Conclusion: We describe a rare fatal case of foetal gas gangrene in the second trimester following premature rupture of membranes which was diagnosed by a computed tomography (CT) scan of the abdomen and pelvis. The CT scan reliably identifies emphysematous changes in the amniotic cavity and foetal parts which helps in decision-making from the induction of labour to early surgical approach to prevent peritonitis and multiorgan failure. We recommend early CT scan in pregnancies complicated by intrauterine infections with shock which can change the line of management.
{"title":"A rare case of fetal gas gangrene following premature rupture of membranes in the second trimester diagnosed with the aid of computed tomography","authors":"K. Gupta, A. Ajith Kumar, Modhulika Bhattacharya, P. Murthy, K. Sarath","doi":"10.4103/joacc.joacc_85_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_85_21","url":null,"abstract":"Introduction: To report a rare case of foetal gas gangrene following premature rupture of membranes in the second trimester diagnosed with the aid of computed tomography. Case Report: A 33-year-old lady, with G4A2L1, booked and vaccinated, developed premature rupture of membranes at 25 weeks of gestation. She developed severe abdominal pain with high-grade fever on the fourth night after expectant management with intravenous antibiotics and close monitoring. As there was a new-onset shock, she was referred to the higher centre from the obstetric care unit. The ultrasound of the abdomen and pelvis in the emergency room ruled out other causes of shock but confirmed intrauterine death. After planning for vaginal delivery, she had further deterioration requiring intubation and vasopressors. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis was performed which showed foetal gas gangrene and bilateral acute cortical necrosis. Emergency hysterotomy, performed under high-risk consent delivered macerated foetus. She had atonic uterus and required obstetric hysterectomy under general anaesthesia (GA). Her post-partum course was complicated by disseminated intravascular coagulopathy (DIC), acute respiratory distress syndrome (ARDS) and multiorgan dysfunction syndrome requiring multiple transfusions, prone ventilation and multiorgan support. However, she could not be salvaged and died on the 2nd day of surgery. Conclusion: We describe a rare fatal case of foetal gas gangrene in the second trimester following premature rupture of membranes which was diagnosed by a computed tomography (CT) scan of the abdomen and pelvis. The CT scan reliably identifies emphysematous changes in the amniotic cavity and foetal parts which helps in decision-making from the induction of labour to early surgical approach to prevent peritonitis and multiorgan failure. We recommend early CT scan in pregnancies complicated by intrauterine infections with shock which can change the line of management.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42709232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/joacc.joacc_66_21
Y. Kawatsu, M. Miyazu, T. Kojima
Pregnancy-related Group A streptococcus (GAS) sepsis is a rare, rapidly progressing life-threatening disease. Previous reports described the clinical features of pregnancy-related GAS sepsis, however, the evidence regarding general anesthesia is extremely limited. This report aims to alert anesthesiologists that pregnancy-related GAS sepsis is an emerging life-threatening disease and to describe the clinical issues when performing general anesthesia in the emergency cesarian section. We describe the case of a 37-year-old pregnant woman with undiagnosed pregnancy-related GAS sepsis who exhibited rapid, progressive circulatory collapse. Attentive anesthesia management and smooth transition to the cesarean section resulted in saving both the mother and baby without any complications. The evidence regarding anesthesia management in pregnancy-related GAS sepsis is extremely lacking. To make the diagnosis of GAS sepsis before initiating the emergency cesarean section was challenging under rapid deterioration. Anesthesiologists should consider GAS sepsis in pregnancy with aggressive septic features and prepare for the fatal intraoperative complications during general anesthesia.
{"title":"Successful anesthesia case of emergency cesarean section complicated with pregnancy-related group: A streptococcus sepsis","authors":"Y. Kawatsu, M. Miyazu, T. Kojima","doi":"10.4103/joacc.joacc_66_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_66_21","url":null,"abstract":"Pregnancy-related Group A streptococcus (GAS) sepsis is a rare, rapidly progressing life-threatening disease. Previous reports described the clinical features of pregnancy-related GAS sepsis, however, the evidence regarding general anesthesia is extremely limited. This report aims to alert anesthesiologists that pregnancy-related GAS sepsis is an emerging life-threatening disease and to describe the clinical issues when performing general anesthesia in the emergency cesarian section. We describe the case of a 37-year-old pregnant woman with undiagnosed pregnancy-related GAS sepsis who exhibited rapid, progressive circulatory collapse. Attentive anesthesia management and smooth transition to the cesarean section resulted in saving both the mother and baby without any complications. The evidence regarding anesthesia management in pregnancy-related GAS sepsis is extremely lacking. To make the diagnosis of GAS sepsis before initiating the emergency cesarean section was challenging under rapid deterioration. Anesthesiologists should consider GAS sepsis in pregnancy with aggressive septic features and prepare for the fatal intraoperative complications during general anesthesia.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48798143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/joacc.joacc_32_21
M. Venkataraman, N. Basker, L. Prakash
Background and Aims: COVID-19 has been a globally concerning pandemic affecting more than 20 million people worldwide. Due to physiological and anatomical changes, pregnant women are more susceptible to viral respiratory infections. Although the clinical and radiological features of COVID positive pregnant and non-pregnant women are comparable, literature pertaining to the clinical presentation and the outcomes in COVID positive pregnant women are being researched upon. Aims and Objectives: The main objective is to assess the lung involvement in COVID-19 positive pregnant women based on their clinical presentation and CT imaging features. The secondary aim is to study their clinical outcomes based on the above findings. Methods: This was a retrospective study carried out on COVID-19 positive pregnant women admitted to our hospital over 6 months (from May 2020 to October 2020). The collected data were analyzed with IBM.SPSS statistics software 23.0 Version. Results: There were a total of 480 COVID positive antenatal women detected Out of 480 patients 75.8% (364) were asymptomatic, one hundred and two patients (21.3%) presented with mild symptoms such as fever, dry cough, runny nose, loss of taste/smell without any breathing difficulty. Fourteen patients (2.9%) were identified in the moderate to severe symptomatic category with lung involvement with a 95% Confidence Intervals between 1.41 and 4.42. Three patients sustained mortality, the overall Mortality rate being 0.6%. Conclusion: The majority of the COVID positive antenatal women are asymptomatic or present with mild symptoms as detected from this study. Only a small proportion (2.9%) were identified with respiratory compromise. Although their infectivity rate is quite high, 99.4% of the population were cured and discharged.
{"title":"Lung involvement in COVID-19 positive pregnant women and their outcomes – A clinical and imaging based retrospective case study","authors":"M. Venkataraman, N. Basker, L. Prakash","doi":"10.4103/joacc.joacc_32_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_32_21","url":null,"abstract":"Background and Aims: COVID-19 has been a globally concerning pandemic affecting more than 20 million people worldwide. Due to physiological and anatomical changes, pregnant women are more susceptible to viral respiratory infections. Although the clinical and radiological features of COVID positive pregnant and non-pregnant women are comparable, literature pertaining to the clinical presentation and the outcomes in COVID positive pregnant women are being researched upon. Aims and Objectives: The main objective is to assess the lung involvement in COVID-19 positive pregnant women based on their clinical presentation and CT imaging features. The secondary aim is to study their clinical outcomes based on the above findings. Methods: This was a retrospective study carried out on COVID-19 positive pregnant women admitted to our hospital over 6 months (from May 2020 to October 2020). The collected data were analyzed with IBM.SPSS statistics software 23.0 Version. Results: There were a total of 480 COVID positive antenatal women detected Out of 480 patients 75.8% (364) were asymptomatic, one hundred and two patients (21.3%) presented with mild symptoms such as fever, dry cough, runny nose, loss of taste/smell without any breathing difficulty. Fourteen patients (2.9%) were identified in the moderate to severe symptomatic category with lung involvement with a 95% Confidence Intervals between 1.41 and 4.42. Three patients sustained mortality, the overall Mortality rate being 0.6%. Conclusion: The majority of the COVID positive antenatal women are asymptomatic or present with mild symptoms as detected from this study. Only a small proportion (2.9%) were identified with respiratory compromise. Although their infectivity rate is quite high, 99.4% of the population were cured and discharged.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49288936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/joacc.joacc_62_21
S. Olateju, B. Osinaike, O. Salami, A. Adetoye, O. Fatungase, O. Aaron, A. Faponle, on behalf of NiSOS
Background: Elective caesarean deliveries are planned procedures which are not without complications and unfavorable outcomes. We aimed to assess anaesthetic complications, risk factors and outcomes during caesarean delivery in Nigerian hospitals. Materials and Methods: Using a standardized template, we conducted a multi-centre prospective cohort study of parturients presenting for elective caesarean deliveries over a seven-day period in 49 hospitals. Demographic data of enrolled parturients, anaesthetic and surgical characteristics, complications; maternal and neonatal outcomes; ICU admissions and indications were collected. Results: A total of 237 parturients were studied. Previous caesarean section 50 (21%) and preeclampsia 25 (10.5%) were the most common indications for surgery. Regional technique was the most frequently used anaesthetic technique 221 (93.2%). Hypotension was more common with regional technique 29 (13%) than with general anaesthesia 6 (1%). The vast majority (71.8%) of those that developed complications had co-morbidities. Six patients were admitted to the ICU. Obstetric haemorrhage and severe preeclampsia were the most common indications for ICU admissions, 50% and 33% respectively. Two intraoperative cardiac arrests occurred with one survivor. There was one fresh stillbirth, three neonatal admissions and no neonatal death. Conclusion: Hypotension was the most common intraoperative complication during elective caesarean section whilst obstetric haemorrhage remained the major indication for ICU admissions with good outcomes.
{"title":"Anaesthetic complications during elective caesarean delivery and outcomes: A nigerian multi-centre cohort study","authors":"S. Olateju, B. Osinaike, O. Salami, A. Adetoye, O. Fatungase, O. Aaron, A. Faponle, on behalf of NiSOS","doi":"10.4103/joacc.joacc_62_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_62_21","url":null,"abstract":"Background: Elective caesarean deliveries are planned procedures which are not without complications and unfavorable outcomes. We aimed to assess anaesthetic complications, risk factors and outcomes during caesarean delivery in Nigerian hospitals. Materials and Methods: Using a standardized template, we conducted a multi-centre prospective cohort study of parturients presenting for elective caesarean deliveries over a seven-day period in 49 hospitals. Demographic data of enrolled parturients, anaesthetic and surgical characteristics, complications; maternal and neonatal outcomes; ICU admissions and indications were collected. Results: A total of 237 parturients were studied. Previous caesarean section 50 (21%) and preeclampsia 25 (10.5%) were the most common indications for surgery. Regional technique was the most frequently used anaesthetic technique 221 (93.2%). Hypotension was more common with regional technique 29 (13%) than with general anaesthesia 6 (1%). The vast majority (71.8%) of those that developed complications had co-morbidities. Six patients were admitted to the ICU. Obstetric haemorrhage and severe preeclampsia were the most common indications for ICU admissions, 50% and 33% respectively. Two intraoperative cardiac arrests occurred with one survivor. There was one fresh stillbirth, three neonatal admissions and no neonatal death. Conclusion: Hypotension was the most common intraoperative complication during elective caesarean section whilst obstetric haemorrhage remained the major indication for ICU admissions with good outcomes.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46293889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Enhanced recovery programs result in reduced morbidity in terms of effective pain control, reduced length of stay (LOS), and an earlier return to normal activities. This study has been conducted to compare Enhanced recovery after caesarean (ERAC) protocol to traditional care of cesarean section (CS) in our institute. Materials and Methods: Patients undergoing elective CS were subjected to ERAC protocol (Group A; n = 100) for first six months and traditional protocol (Group B; n = 100) for next six months. Primary outcome was comparison of total duration of stay (readiness to discharge) in the hospital, whereas secondary objectives were intraoperative hemodynamic control and requirement of vasopressor, comparison of Visual Analogue Scale (VAS) scores and requirement of analgesics in 24 hrs, barriers to implementation of ERAC components, urinary retention and need of recatheterization and any adverse events perioperatively. Results: Significant reduction in LOS or readiness for discharge was found in Group A; 2.85 ± 0.5 vs 5.25 ± 0.61 hrs in Group B (p < 0.0001). Episodes of hypotension and requirement of phenylephrine was significantly more in Group B. (p < 0.0001) VAS scores in Group A were significantly less postoperatively with significant reduction in consumption of rescue analgesic in 24 hrs. (p < 0.001) Components of ERAC protocol were implemented successfully with significant difference in time of ambulation, decatheterization, and resumption of oral feed postoperatively. Conclusion: Implementation of ERAC results in significant reduction in LOS in hospital with better pain relief and reduced postoperative opioid requirement following cesarean delivery.
{"title":"Enhanced recovery after cesarean protocol versus traditional protocol in elective cesarean section: A prospective observational study","authors":"Sunanda Gupta, Apoorva Gupta, Aditi Baghel, Karuna Sharma, S. Choudhary, Vidhu Choudhary","doi":"10.4103/joacc.joacc_16_22","DOIUrl":"https://doi.org/10.4103/joacc.joacc_16_22","url":null,"abstract":"Background: Enhanced recovery programs result in reduced morbidity in terms of effective pain control, reduced length of stay (LOS), and an earlier return to normal activities. This study has been conducted to compare Enhanced recovery after caesarean (ERAC) protocol to traditional care of cesarean section (CS) in our institute. Materials and Methods: Patients undergoing elective CS were subjected to ERAC protocol (Group A; n = 100) for first six months and traditional protocol (Group B; n = 100) for next six months. Primary outcome was comparison of total duration of stay (readiness to discharge) in the hospital, whereas secondary objectives were intraoperative hemodynamic control and requirement of vasopressor, comparison of Visual Analogue Scale (VAS) scores and requirement of analgesics in 24 hrs, barriers to implementation of ERAC components, urinary retention and need of recatheterization and any adverse events perioperatively. Results: Significant reduction in LOS or readiness for discharge was found in Group A; 2.85 ± 0.5 vs 5.25 ± 0.61 hrs in Group B (p < 0.0001). Episodes of hypotension and requirement of phenylephrine was significantly more in Group B. (p < 0.0001) VAS scores in Group A were significantly less postoperatively with significant reduction in consumption of rescue analgesic in 24 hrs. (p < 0.001) Components of ERAC protocol were implemented successfully with significant difference in time of ambulation, decatheterization, and resumption of oral feed postoperatively. Conclusion: Implementation of ERAC results in significant reduction in LOS in hospital with better pain relief and reduced postoperative opioid requirement following cesarean delivery.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46587194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/joacc.joacc_79_21
Joshua Falescky, M. Gerasimov, J. Aronsohn, G. Palleschi
Hereditary spastic paraplegia (HSP) is a rare, inherited condition affecting the corticospinal tract, typically characterized by bilateral lower extremity weakness and stiffness. HSP presents challenges to anesthetic management, particularly in the obstetric population due to the paucity of existing recommendations in the literature. Although case reports exist regarding the successful use of general and neuraxial anesthesia for cesarean section, none currently exist with regard to labor analgesia. Here, we report the use of labor epidural anesthesia in a 29-year-old woman with HSP. She delivered via cesarean delivery after laboring for 27 h with an epidural catheter in place. The patient tolerated epidural placement well with no adverse neurologic sequelae. The utilization of neuraxial techniques avoids the risks associated with airway manipulation in a parturient and obviates the need for the use of muscle relaxants in the setting of upper motor neuron disease. Epidural anesthesia appears to be a safe approach to the management of labor and cesarean delivery in a parturient with HSP.
{"title":"Neuraxial anesthesia for a laboring patient with hereditary spastic paraplegia: A case report","authors":"Joshua Falescky, M. Gerasimov, J. Aronsohn, G. Palleschi","doi":"10.4103/joacc.joacc_79_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_79_21","url":null,"abstract":"Hereditary spastic paraplegia (HSP) is a rare, inherited condition affecting the corticospinal tract, typically characterized by bilateral lower extremity weakness and stiffness. HSP presents challenges to anesthetic management, particularly in the obstetric population due to the paucity of existing recommendations in the literature. Although case reports exist regarding the successful use of general and neuraxial anesthesia for cesarean section, none currently exist with regard to labor analgesia. Here, we report the use of labor epidural anesthesia in a 29-year-old woman with HSP. She delivered via cesarean delivery after laboring for 27 h with an epidural catheter in place. The patient tolerated epidural placement well with no adverse neurologic sequelae. The utilization of neuraxial techniques avoids the risks associated with airway manipulation in a parturient and obviates the need for the use of muscle relaxants in the setting of upper motor neuron disease. Epidural anesthesia appears to be a safe approach to the management of labor and cesarean delivery in a parturient with HSP.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47597589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/joacc.joacc_72_21
James Skelly, Siaghal MacColgáin
Klippel–Feil Syndrome (KFS) is a complex heterogeneous entity that can result in cervical spondylosis and thoracolumbar vertebral fusion. Combined, these features contribute to both a difficult airway and neuraxial anaesthesia. Previously, these patients required general anaesthesia in the obstetric setting, incorporating advanced airway techniques as the first line. Herein, we describe the novel use of the paramedian approach to epidural anaesthesia in a primigravid woman, with a background of KFS. The patient had a vaginal septum and double cervix and was considered at higher risk of obstetric complications. Antenatal assessment and forward planning within the multidisciplinary team setting were vital in the formulation and provision of safe care for this patient. Neuraxial ultrasound (US), undertaken at preassessment, yielded adequate views of the posterior complex in the paramedian sagittal oblique plane only. An anaesthetic plan with emphasis on early paramedian epidural insertion was thus formulated. The patient was admitted to early labour by the obstetric team. Neuraxial US replicated the previously attained windows and in keeping with the plan, the paramedian approach was utilised with successful insertion on the first attempt. Patient-controlled epidural anaesthesia infusion was utilised over her 6-hour labour with instrumental delivery. Epidural analgesia was maintained with a bilateral T6 sensory block with the patient comfortable throughout. This case study outlines the novel use of the paramedian approach to epidural anaesthesia in a patient with KFS. We also believe it exemplifies the need to pre-assess patients with abnormal spinal anatomy and utilises the neuraxial US to formulate an anaesthetic plan.
{"title":"Case report: Utilisation of the paramedian approach to epidural insertion in a case of klippel-feil syndrome","authors":"James Skelly, Siaghal MacColgáin","doi":"10.4103/joacc.joacc_72_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_72_21","url":null,"abstract":"Klippel–Feil Syndrome (KFS) is a complex heterogeneous entity that can result in cervical spondylosis and thoracolumbar vertebral fusion. Combined, these features contribute to both a difficult airway and neuraxial anaesthesia. Previously, these patients required general anaesthesia in the obstetric setting, incorporating advanced airway techniques as the first line. Herein, we describe the novel use of the paramedian approach to epidural anaesthesia in a primigravid woman, with a background of KFS. The patient had a vaginal septum and double cervix and was considered at higher risk of obstetric complications. Antenatal assessment and forward planning within the multidisciplinary team setting were vital in the formulation and provision of safe care for this patient. Neuraxial ultrasound (US), undertaken at preassessment, yielded adequate views of the posterior complex in the paramedian sagittal oblique plane only. An anaesthetic plan with emphasis on early paramedian epidural insertion was thus formulated. The patient was admitted to early labour by the obstetric team. Neuraxial US replicated the previously attained windows and in keeping with the plan, the paramedian approach was utilised with successful insertion on the first attempt. Patient-controlled epidural anaesthesia infusion was utilised over her 6-hour labour with instrumental delivery. Epidural analgesia was maintained with a bilateral T6 sensory block with the patient comfortable throughout. This case study outlines the novel use of the paramedian approach to epidural anaesthesia in a patient with KFS. We also believe it exemplifies the need to pre-assess patients with abnormal spinal anatomy and utilises the neuraxial US to formulate an anaesthetic plan.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47915775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/joacc.joacc_63_21
R. Khetarpal, V. Chatrath, Puneetpal Kaur, A. Trikha
Assisted reproductive technology (ART) is used primarily to address the treatment of infertility which includes medical procedures such as in vitro fertilisation (IVF), intra-cytoplasmic sperm injection (ICSI), gamete intra-fallopian transfer (GIFT) or zygote intra-fallopian transfer (ZIFT). IVF has revolutionised infertility treatment and is nowadays widely accepted all over the world. The IVF is carried out as a daycare procedure and many anaesthetic regimens have been studied, tried and tested so far. An anaesthesiologist's role mainly comes into play during trans- vaginal oocyte retrieval and embryo transfer (ET) process of IVF. Various techniques of anaesthesia are practised which include general or regional anaesthesia, conscious sedation or monitored anaesthesia care, patient-controlled analgesia, acupuncture and transcutaneous electrical nerve stimulation (TENS). The anaesthetic management needs careful consideration of the effect of drugs on the maturation of oocytes or embryonic development, fertilisation and pregnancy rates. In view of the Coronavirus disease-19 (COVID-19) pandemic, ART clinics have been affected and due to the ambiguity of its effects on the reproductive outcome, anaesthesiologists need to be vigilant and cautious with anaesthetic management during pandemic times. This review includes a discussion of various anaesthetic options and agents along with their advantages or disadvantages if any. The literature sources for this review were obtained via PubMed, Medline, Cochrane Library and Google Scholar. The results of 82 out of 110 articles discussing different methods of anaesthesia for ART procedures over 25 years were compiled.
{"title":"Anaesthesia for assisted reproductive technology (ART): A narrative review","authors":"R. Khetarpal, V. Chatrath, Puneetpal Kaur, A. Trikha","doi":"10.4103/joacc.joacc_63_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_63_21","url":null,"abstract":"Assisted reproductive technology (ART) is used primarily to address the treatment of infertility which includes medical procedures such as in vitro fertilisation (IVF), intra-cytoplasmic sperm injection (ICSI), gamete intra-fallopian transfer (GIFT) or zygote intra-fallopian transfer (ZIFT). IVF has revolutionised infertility treatment and is nowadays widely accepted all over the world. The IVF is carried out as a daycare procedure and many anaesthetic regimens have been studied, tried and tested so far. An anaesthesiologist's role mainly comes into play during trans- vaginal oocyte retrieval and embryo transfer (ET) process of IVF. Various techniques of anaesthesia are practised which include general or regional anaesthesia, conscious sedation or monitored anaesthesia care, patient-controlled analgesia, acupuncture and transcutaneous electrical nerve stimulation (TENS). The anaesthetic management needs careful consideration of the effect of drugs on the maturation of oocytes or embryonic development, fertilisation and pregnancy rates. In view of the Coronavirus disease-19 (COVID-19) pandemic, ART clinics have been affected and due to the ambiguity of its effects on the reproductive outcome, anaesthesiologists need to be vigilant and cautious with anaesthetic management during pandemic times. This review includes a discussion of various anaesthetic options and agents along with their advantages or disadvantages if any. The literature sources for this review were obtained via PubMed, Medline, Cochrane Library and Google Scholar. The results of 82 out of 110 articles discussing different methods of anaesthesia for ART procedures over 25 years were compiled.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46630220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/joacc.joacc_48_21
A. Chhabra, Prajakta D Shinde, V. Shetty, A. Ganatra
Sub-valvular aortic stenosis (SAS) occurs due to a fibrous membrane or a muscular narrowing causing left ventricular outflow tract obstruction. The physiological changes of pregnancy may exacerbate the cardiac condition posing significant challenges for anaesthesia and surgery. A 34 years primigravida, with 32 weeks gestation, a known case of sub-valvular aortic stenosis presented in the emergency room in view of leaking/bleeding per-vagina. Risk factors such as tachycardia, decrease in afterload, preload and increased left ventricle contractility lead to exacerbation of the obstruction and should be avoided. We report a successful anaesthetic management of her lower segment cesarean section while balancing the physiological changes of pregnancy superimposed by pathology of the disease.
{"title":"Anaesthetic management of a patient with sub-valvular aortic stenosis for emergency lower segment caesarean section: A case report","authors":"A. Chhabra, Prajakta D Shinde, V. Shetty, A. Ganatra","doi":"10.4103/joacc.joacc_48_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_48_21","url":null,"abstract":"Sub-valvular aortic stenosis (SAS) occurs due to a fibrous membrane or a muscular narrowing causing left ventricular outflow tract obstruction. The physiological changes of pregnancy may exacerbate the cardiac condition posing significant challenges for anaesthesia and surgery. A 34 years primigravida, with 32 weeks gestation, a known case of sub-valvular aortic stenosis presented in the emergency room in view of leaking/bleeding per-vagina. Risk factors such as tachycardia, decrease in afterload, preload and increased left ventricle contractility lead to exacerbation of the obstruction and should be avoided. We report a successful anaesthetic management of her lower segment cesarean section while balancing the physiological changes of pregnancy superimposed by pathology of the disease.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46955359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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